Girls as young as 13 hooked on family planning
High above the routine, commonplace slog of Waa village in Kwale, a dense formation of coastal clouds drifts lazily across the sky. Below it, a gentle gust of wind swishes a woman’s long turquoise blue skirt up her bent back.
Embarrassed by the ignominy, she straightens up, pulls the skirt down to position, then bends again to wring water out of a tiny pink dress and a number of cloth napkins she has been washing, before putting them to dry on a line fastened on two palm trees.
Her maternal care is natural, and these chores mean the world to her. But that beautiful scene is ended by a call for help from one of the mud houses in the homestead.
“She cannot latch properly, mama!” a tiny voice wails, in Kiswahili. “And my breasts are sore!”
Ms Saumu Baushi, 34, sighs, abandons her washing, and walks into the house. Inside, a small girl sits on a bed, holding a two-week-old baby, one of her breasts exposed. She looks eleven. Or twelve.
“This is my 14-year-old first-born daughter,” Ms Baushi explains. “She gave birth two weeks ago but she does not even know how to position the baby on her breast. So I have to hold the baby and help it suckle.”
MOTHERS AT YOUNG AGE
Ms Baushi is one among many mothers in this little village in Kwale County whose daughters have become mothers at a very young age.
And, as Kenya marks the World Contraception Day Monday, the policies and guidelines under debate will strike a sensitive cord in her heart.
“I am taking her to the dispensary today to put her on family planning,” she announces to us, matter-of-factly, referring to the daughter who is struggling to breastfeed her progeny.
“If she has brought me a grandchild at this age, how sure am I she won’t get another child? She will get the Depo-Provera shot and will be on it until she finishes her studies.”
Depo-Provera is a contraceptive injection for women that contains the hormone progestin, and while in Kenya it has traditionally been associated with married women who want to space their children or prevent conception altogether, here in sleepy Waa a girl who is barely in her teens is about to get the shot.
“I know it is a decision some people would frown over,” explains the girl’s mother, “but look at me; I am a grandmother at 34 years!”
The 2014 Kenya Demographic Health Survey shows that half of women in Kenya aged between 20 and 49 had their first sexual intercourse by the time they turned 18, and that one in 10 women of the same group had their sexual debut by 15.
One in four Kenyan women aged between 25 and 49 have given birth by age 18, while one in two have given birth by 20.
Health workers say teenagers, some as young as 13, are now on various family planning options, and this surge may be driven by the high number of teenage pregnancies as a bigger portion opts to use contraceptives after getting their first child.
“In every facility in Lunga Lunga Sub-County, there are mothers who are under the age of 19 years seeking antenatal care services,” says Ms Lele Hassan Matano, the local public health nurse.
The use of contraceptives by adolescents is a sensitive issue in a country with strong religious inclinations, and although government policy is to ensure availability of such services for men and women who are ready for, and need, them, the society is yet to wrap its collective head around the reality of teens on pills.
“We have informed our health care workers that, for family planning to be successful, the entry point is the sexual activity of an individual. So when a teenager comes for the services, the health worker should not deny them contraceptives,” Ms Matano says.
Her views are supported by Mr David Baya, the Kwale County health promotion officer, who says parents need to realise that the sexual activities of their children, while predisposing them to infections, also expose them to unwanted pregnancies.
Ms Ali, a resident of Kwale, put her twin daughters on contraceptives when they were in Standard Seven.
“I had to have a plan so that they do not get pregnant again easily. How do I take care of them and their children at the same time?” she asks. “It is better to prevent at least one thing — in this case pregnancy — than them come here with both infections and pregnancies.”
Ms Mwanajuma Magadi, a nurse at Waa Dispensary, says while they offer contraceptive services to teenagers, they also advise them on the importance of protecting themselves from STDs and ask them to use condoms.
“The current generation of children is not one that waits to be told,” she says. “They pick a lot of stuff from social media. We parents think they do not know things like sex, but some know and do things that even we parents are not aware of.”
And the evidence is all over the place: At Waa Primary School, the bell goes for lunch break. As others rush to the dining hall, 15-year-old Mwanaisha, who is in Standard Six, heads home to breast-feed her one-year-old son.
We can not reveal the identities of the girls we talked to for this story to protect their privacies and rights.
“The only thing I have to do now is take care of the baby and read until I complete my primary school education,” she says when we catch up with her. “I am on contraceptives, so at least I am sure I will not get pregnant again. I have been receiving the three-month injection since I gave birth one-and-a-half years ago while in Standard Four.”
This shocking narrative of young girls, some barely in their teens, on birth control programmes is repeated by several other teenage girls in this region.
Some are mothers already, others got on contraceptives before they could conceive, herded to the clinics by their mothers or friends.
Saida, a 21-year-old Form Two girl, has had the Jadelle implant inserted in her arm for the last two years. Before that, she used Depo-Provera for two years.