Policy Brief

No. 31 June 2013

Collaborating Organizations: Ministry of Public Health and Sanitation

and Population Reference Bureau (PRB)

Teenage Pregnancy is Harmful to Women’s Health

in Kenya

A
dolescent girls who give birth have a much higher risk of dying from
complications of pregnancy and childbirth than do women in their 20s and 30s.1
Moreover, the babies born to adolescents face a higher risk of death compared
to babies born to older women.

Worldwide, an estimated 287,000 women and girls Figure 1: Percentage of Women Ages 15-19 Who Have
die each year of complications related to pregnancy Begun Childbearing, by Age and Place of Residence
and childbirth.2 Over 99 percent of those deaths 40 –
36
occur in developing countries such as Kenya. Some 35 –
of the main complications include severe bleeding, 30 –
PERCENT

obstructed labor, hypertension (pre-eclampsia), 25 –

26

unsafe abortion and malaria. But the deaths tell 19

20 – 18
only part of the story. For every woman or girl 17
15 –
who dies during childbirth, between 20 and 30
10 – 9
more will develop short- and long-term disabilities.3
5–
2
Childbirth can be especially risky for adolescent 0
15 16 17 18 19 Urban Rural
girls and their babies: Maternal death rates for Age and Place of Residence
young women ages 15 to 19 are twice as high as Source: Kenya National Bureau of Statistics and ICF International, Kenya Demographic
and Health Survey 2008-09.
for women in their 20s, and research suggests that
girls ages 10 to 14 are five times more likely to die In terms of regional differences, Figure 2 shows that the levels
of maternal causes than women ages 20 to 24.4 of teenage childbearing are highest in Nyanza (27 percent)
First-time, adolescent mothers are at most risk. and Coast (26 percent) provinces and lowest in Central
province (10 percent).
This brief explores teenage pregnancy and its
harmful health consequences in Kenya and
proposes measures that could help reduce early Figure 2: Percentage of Women Ages 15-19 Who Have
Had a Live Birth or Who are Pregnant With Their First
pregnancy and childbearing in Kenya. Child, by Region
30 –
How prevalent is teenage 26
27

25 –
pregnancy in Kenya?
PERCENT

Figure 1 shows the proportion of teenagers that 20 – 18

17
have had children by age and place of residence 15 – 14 14
15
16

in Kenya.5 Teenage childbearing is common and 10

10 –
increases dramatically from 2 percent of girls at age
15 to 36 percent at age 19. 5–

0
Nairobi Central Coast Eastern Nyanza Rift Western North Kenya
Valley Eastern
Region
Source: Kenya National Bureau of Statistics and ICF International, Kenya Demographic
and Health Survey 2008-09.
Why does teenage pregnancy persist implications for their health and well-being, as they are
in Kenya? more likely to suffer pregnancy-related complications
Premarital sex is common in Kenya. The average age than older women.10 FGM violates several basic rights
at first sex among Kenyan women is about two years of women and girls, including the right to liberty and
younger than the average age at first marriage. Nearly security and the right to be free of inhumane and
40 percent of unmarried women ages 15 to 24 have degrading treatment. These violations have severe
had premarital sex, and more than one in seven are psychological, emotional, and medical consequences,
sexually active.6 including increased risk of unintended pregnancy and
sexually transmitted infections, such as HIV.11
Teenage pregnancy persists for a number of reasons,
including inadequate access to reproductive health Poverty
information and services, cultural and religious taboos, Poverty pushes girls into activities that expose them
and poverty. to sexual exploitation and having sex in exchange for
money and food. In such situations, young girls are
Lack of information on sexuality not in a position to negotiate safer sex and are often
Sex education, both in schools and in the home, at risk of pregnancy, sexually transmitted infections,
is inadequate in Kenya. Few adolescents receive including HIV, and violence such as rape.12
comprehensive sex education, and often teachers
do not have sufficient training to give students
What are the health consequences of
correct information. While the Ministry of Education
teenage pregnancy?
acknowledges the need to provide information on
sexuality, the lack of access to comprehensive sex The fifth Millennium Development Goal aims to
education in schools contributes to teenage pregnancy reduce the number of global maternal deaths by 75
and its consequences.7 percent between 1990 and 2015. In Kenya, maternal
deaths were estimated at 360 deaths per 100,000 live
Another barrier to providing sex education in schools births in 2010, a decline of less than 10 percent since
is the resistance by religious organizations who 1990.13 A significant portion of women dying from
claim that the responsibility lies with the parents. pregnancy-related causes is under age 18. In Kenya,
Yet, parents do not have the skills or the information the regions with the highest teenage pregnancy rates
to help young people understand all of the issues (Figure 2) also have the highest maternal death rates.
surrounding sexuality. Most of the time, young people These areas include parts of the Rift Valley, Coast,
are expected to gather information on their own.8 Nyanza, and Western and Northern Kenya.14

Religious and Cultural Reasons

Another consequence of teenage pregnancy is
unsafe abortion. Evidence indicates that about
In Kenya, religious and cultural taboos prevent
317,000 abortions—both miscarriages and induced
open dialogue about premarital sex at home and in
abortions—occur in the country each year, causing an
schools, despite the fact that such sexual activity is
estimated 20,000 women and girls to be hospitalized
common. Opposition from religious and community
with complications and 2,600 deaths.15 In other
leaders and policymakers has often prevented young
words, about 1 percent of women admitted to
people from accessing the information and services
public hospitals are dying from abortion-related
that would enable them to meet their sexual and
complications. Nearly 50 percent of abortions occur
reproductive health needs. Even where services exist,
in women between the ages of 14 and 24.
the providers’ negative attitudes about adolescent
sexuality and the rights of young people create serious
barriers and prevent young people from accessing Do Kenyan laws and policies support
these services.9 adolescents’ right to health care?
Over the last decade, many laws and policies have
Harmful practices such as child marriage, female
been enacted to enhance the well-being of youth
genital mutilation (FGM), violence, and sexual abuse
and support their right to health care.16 Despite the
also exacerbate the situation. Girls who marry young
progress made in the policy arena, however, the slow
often start childbearing before they are physiologically
pace of implementation of programs that promote
and psychologically mature. This has serious
youth empowerment in all sectors is a major setback.

2 NCPD Policy Brief No. 31 – June 2013

The following are examples: Recommendations
To reduce teenage pregnancy and its harmful health
l Kenya’s new constitution provides a legal
consequences, the government and other stakeholders
framework that seeks to ensure more rights-based,
must address the underlying social, cultural, and
comprehensive, and people-driven health services.17
economic factors that contribute to pregnancy
The constitution states that every person has the
and childbearing among adolescents. Programmes
right to the highest attainable standard of health,
that target youth must be designed to take into
and it singles out health care for specific groups
account their special needs; they must combine both
such as children and persons living with disabilities.
information and services, and be designed with the
l The Population Policy for National Development consultation of youth for whom they are intended.22
recognizes that two-thirds of the Kenyan They must be of high quality, accessible, and
population is under age 25, and proposes a affordable, and must offer a comprehensive package
number of measures to improve the well-being of that encourages youth to seek services. Above all,
adolescents and young people. It advocates for they must be implemented with the support of the
the implementation of the national youth policy communities where they are located.
through the strengthening of youth empowerment
centers; promotes a multisectoral approach to
Priority actions include:
provide youth-friendly population education and
l Full implementation and enforcement of policies
reproductive health services; and advocates for
and legislation such as the National Reproductive
family life education for both in- and out-of-school
Health policy (2007), the Adolescent Health and
youth.18
Development Policy (2003), and the Kenya Health
l The National Reproductive Health Policy seeks to Policy of 2012, recognizing that access to quality
improve the reproductive status of all people in health care as a right for every person, including
Kenya and outlines priority actions to ensure that the adolescents and young adults. The government
adolescents and youth have full access to sexual and should promote a multisectoral approach by
reproductive health information and services.19 encouraging civil society and the private sector
to get involved in the implementation of various
l The Adolescent Reproductive Health and policies.
Development Policy of 2003 recognizes that the
optimal health of the adolescent population of l Eliminate barriers that prevent adolescents from
Kenya will increase their productive capacity to obtaining family planning services. The government
contribute to the nation’s development.20 The should ensure that public-sector facilities reach
policy identifies barriers to improved sexual and those who are poor and young with free or low-
reproductive well-being of young people as well as cost family planning services. Programs should offer
priority actions to address these problems. comprehensive family planning services, enabling
women to choose the best methods for themselves
Despite the government’s efforts to develop laws by providing counseling, information, and a wide
and policies such as these, implementation has been range of contraceptive methods.23
weak and inconsistent. One example is the Children
Act 2001: Although it outlaws FGM, the practice l Enforce existing laws on the minimum age of
is still widespread and most people are unaware marriage. Although the legal age for marriage is 18
of law’s existence.21 The act also makes education years, many women under this age are married, with
compulsory, but most parents either do not know no consequences for any parties involved.24
of its existence or they ignore it. The poor linkage
l Keeping girls in school past the primary
between government structures and communities
years, as evidence shows, increases the age at
is one of the factors contributing to the lack of
which they marry and become pregnant. The
knowledge and the weak implementation. Also, deeply
government should expand free and compulsory
entrenched cultural practices contribute significantly
basic education to include secondary education.
to the weak implementation and monitoring of policy
They should also increase opportunities for post-
and legislation.
secondary training to enable adolescents and young
women to acquire professional jobs to improve
their quality of life.

Teenage Pregnancy is Harmful to Women’s Health in Kenya 3

 NCPD is a semi-autonomous l Investing in girls’ education is a “best buy” with multiple benefits for
government agency that formulates the young women, their future families, communities and countries.25 To
and promotes population policy and safeguard investments in education for girls, programs should be put in
coordinates related activities for place to address issues such as teenage pregnancy and school drop-outs.
sustainable development in Kenya. For example, providing comprehensive reproductive health information
and youth-friendly services to young people would significantly reduce
NCPD
the teenage pregnancy rate and ensure that girls make a safe transition to
National Council adulthood.
for Population and
Development l To promote gender equity and equality in decision making in
matters of reproductive health and to contribute to the elimination
PO Box 48994 - GPO,
of harmful practices, reproductive health programs should ensure
Nairobi 00100, Kenya
access to treatment and life-saving health services for those affected by
Tel: 254-20-271-1600/01 harmful practices and gender-based violence; promote male involvement
Fax: 254-20-271-6508 in reproductive health programs; and increase the participation of
households and communities, including religious leaders, in addressing
Email:[email protected]
harmful practices and gender inequality.26

www.ncpd-ke.org
Conclusion
Despite the government’s effort to delay teenage pregnancy and childbearing,
statistics show that progress has been insufficient. Teenage pregnancy
is associated with poor health outcomes, including maternal deaths and
injuries. Adolescent pregnancy is fuelled by socioeconomic and socio-
cultural factors. To effectively reduce teenage pregnancy and its poor health
outcomes, programs should ensure that adolescents and youth have full
access to sexual and reproductive health information and services. This
means establishing high quality, comprehensive, youth-friendly reproductive
health services that address the diverse needs of adolescents and youth,
This publication has been made possible by the including those who are HIV positive, living with a disability, and hard to
Government of Kenya with generous support of the reach. The government must promote a multisectoral approach to address
American people through the United States Agency
for International Development (USAID) under the the sexual and reproductive health needs of adolescents while strengthening
terms of the IDEA Project (No. AID-0AA-A-10-00009). partnerships with nongovernmental and faith-based organizations working
The contents are the responsibility of the National
Council for Population and Development and do not with youth.
necessarily reflect the views of USAID or the United
States government.

References
1
World Health Organization (WHO), “Making Pregnancy Safer,” MPS Notes Vol. 1, No. 1 (Geneva: WHO, 2008).
2
WHO et al, Trends in Maternal Mortality: 1990 to 2010 (Geneva: WHO, 2012).
3
Lori Ashford, Hidden Suffering: Disabilities From Pregnancy and Childbirth in Less Developed Countries (Washington, DC: PRB, 2002).
4
Rhonda Smith et al., Family Planning Saves Lives (Washington, DC: Population Reference Bureau, 2009).
5
Kenya National Bureau of Statistics (KNBS) and ICF Macro, Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro, 2010
6
Guttmacher Institute, “Abortion and Unintended Pregnancy in Kenya,” In Brief, Series 2012, No. 2 (New York: Guttmacher Institute, 2012).
7
Rosemarie Muganda-Onyando and Martin Omondi, Down the Drain: Counting the Cost of Teenage Pregnancy and School Dropout in Nairobi (Nairobi: Center for the Study of Adolescence, 2008).
8
CSA, “The Status of Young People in Kenya: A Situation Analysis,” Unpublished Report (Nairobi: CSA, 2003).
9
Muganda-Onyando and Omondi, Down the Drain, 2008.
10
CSA, The Status of Young People in Kenya, 2003.
11
Government of Kenya, National Reproductive Health Policy (Nairobi: Ministry of Health, 2007).
12
Muganda-Onyando and Omondi, Down the Drain, 2008.
13
WHO et al, Trends in Maternal Mortality, 2012.
14
KNBS and ICF Macro, Kenya Demographic and Health Survey 2008-09.
15
Guttmacher Institute, “Abortion and Unintended Pregnancy in Kenya,” 2012.
16
Muganda-Onyando and Omondi, Down the Drain, 2008.
17
National Council for Law Reporting (NCLR), Constitution of Kenya, 2010 Revised ed., (Nairobi: NCLR, 2010).
18
Government of Kenya, Sessional Paper No. 3 of 2012 Population Policy for National Development (Nairobi: National Council for Population and Development, 2012).
19
Government of Kenya (GoK), National Reproductive Health Policy (Nairobi: Ministry of Health, 2007).
20
GoK, Adolescent Health and Development (ARH/D) Policy (Nairobi: Ministry of Health, 2003).
21
Muganda-Onyando and Omondi, Down the Drain, 2008.
22
Muganda-Onyando and Omondi, Down the Drain, 2008.
23
Rhonda Smith et al., Family Planning Saves Lives, 2009.
24
Muganda-Onyando and Omondi, Down the Drain, 2008.
25
Muganda-Onyando and Omondi, Down the Drain, 2008.
26
GoK, National Reproductive Health Policy, 2007.

© 2013 National Council for Population and Development