REPRODUCTIVE HEALTH RIGHTS: THINGS THEY NEVER TOLD ME AS AN ADOLESCENT!

Living on the edge

I visited my hero woman leader, Amimo who has been a longtime neighbor and friend at her home. Recently I have sought her counsel in the work I do for women‘s empowerment in reproductive health and economics. So one late afternoon on entering her dimly lit room with visitors from the Aga Khan University-Kenya, I found a timid young girl named Sasi sitting on a thin mattress with a peacefully sleeping baby of two weeks. As a health provider, immediately my mind raced to the public health implications for an infant and such a young mum. The girl appeared on the verge of tears whenever she looked at her baby. She seemed to have so many questions that perhaps had no answers, certainly not easy ones.

It was difficult to get her talk because of the traumatic events that she had experienced. Most of the time, Sasi looked at her broken fingernails, recalling the death of her parents who succumbed to HIV /AIDS when she was 3yrs old. This being also confirmed by Amimo. She had been brought up by a succession of many relatives. When one ran out of money, they would send her elsewhere. At that time the stigma of HIV was hard and people wouldn’t want to be associated with such relatives.

The World Women’s Conferences in 1985 and 1995 in Beijing and Kenya caused a revolution in the entire world like a tsunami hitting the shores of Indian Ocean. From presidents, policemen, drivers or the farmers in the villages the talk centered on gender equity. Men felt a grip of helplessness for fear that should the conference demand equality, the kitchen could become a place of judgment to repeal or amend restrictions on women’s socio-economic achievement. The conference in Nairobi was regarded by some as a whip to castrate men into mere heads of the family with no authority to prevent women from pursuing their dreams. However this attitude has come with a price over the years.

Being born to a wonderful couple in the Western part of Kenya, at the time when the ‘Beijing women’ were causing a stir in the whole world. The women of the conference made themselves visible by demanding better working conditions, healthcare, education and more. However, 17 years down the lane to be precise, Sasi orphaned at a tender age of 3 doesn’t feel their impact. She grapples with age old issues of poverty, sexual violence and being robbed of the dignity to enjoy her youth. This vulnerable girl has been plunged into the darkness of uncertainty inside one the biggest slums in Africa, Kibera, Kenya

According to UNICEF in 2007 the number of orphaned and vulnerable children adds up to 1.9 million countrywide.12 % of the households in Kenya are made up of orphans without an adult to take care of them. Orphaned girls often end up being victims of early marriages, parents to their siblings and school drop outs. The outcome of this vulnerability reports 142,000 births to teenage girls annually.

I Only Did It Once

At the tender age of 17, Sasi worked as a casual laborer for a lady who promised to take care of her because she didn’t have parents. There was a man living nearby with whom she had little contact, but one day without announcing his intentions, he pounced and gagged to silence her. The only thing Sasi could remember afterward was an excruciating pain such as she had never known in her life. She mumbles amidst clouds of tears, “It was tragic……… it was once, only once but I don’t want to remember such evil”. Later on the lady employer chased her away without payment.
Currently the world is experiencing increasing acts of sexual violence against minors and many go unreported. Under the UN Convention on Children’s Rights Article 34, a child has the right to be free from any form of sexual abuse. However this right has been heavily contravened by child molesters globally, who, for example, rake in billions of shillings in child pornography and trafficking. Even though trafficking carries a heavy penalty, it has become the second most lucrative illicit business after drug trafficking.

The law on rapists in Kenya is very strict, however too often they are walking free again in the streets. Sexual violence is rife in the urban slums. It is very scary for the girl child or boy to even go on call of nature after 6pm. Because the toilets are built on the outside of residences, the concerned parents have makeshift toilets in form of buckets in one room houses for fear of the children being defiled. A number of NGOs, in the Kibera slums have a gender recovery centre, but it is a drop in the ocean. The Power of Hope (POH) single mothers group whom I interviewed reported that, “it is not easy to report rape. The man can kill you, or you are given money to be silenced and such is the dilemma”. Those girls who get raped and have no one to turn to, too often end up with unintended pregnancies, unsafe abortion or even attempt suicide.

Girls Turned Mothers Too Soon!

The outcome of that sexual violence was unintended pregnancy. Sasi is a single mum, nursing a baby of her own without close family support. All her hopes of a better future are shattered. Life will never be the same again!

At the tender age of 17yrs she is a young girl turned mother too soon! As she looks down at her baby one can’t help imagine how she will narrate to her son in the future who exactly is his dad. She will never be able to tell the baby about his real father (the rapist). The shame and hopelessness is evident from her anguished face. Amimo, interjects, “She is so young. She was brought to me by a relative since I am known as the Women Leader of this area. My income is meager, sustaining the (mother and baby) is hard, but what to do? I can’t chase her away.’’

At the beginning of the new millennium, about 1.7 billion people —more than a quarter of the world's population—were between the ages of 10 and 24, 86 percent living in developing countries. Hence the need to address the socio-economic issues that affect this large population that is dependent for virtually every basic need from their parents and guardians is an urgent and growing concern. According to a Reproductive Health Survey conducted here in Kenya in 2003, youth accounted for 36% of the population and adolescents at 25.9%. The World Health Organization defines an adolescent as one from 10-19 years, and a youth is between 15-24 yrs.

The Constitution of Kenya is very clear on the right to health information, including the right to attain the highest standards of health care. However the youthful population is at increasing risk of sexually transmitted illness and unintended pregnancies. Advocates for youth also report that the degree of sexual experience among the youth varies across regions, but consistently indicating that 52 % of women in Sub-Saharan Africa women at 19yrs have had at least their first sexual intercourse.

With the lack of accurate and accessible information on family planning especially in the urban slums, the world will see more babies booming from young girls. It is difficult to ascertain the number of youths who consistently access and use family planning. The public hospitals across Kenya have tried to promote youth friendly clinics but they are not enough. Teenage pregnancy is on the rise. The youth have turned to their peers for information on safe sex, contraceptives and sexually transmitted illnesses. However, their inexperienced peers give inaccurate information. 70% of all adolescents in the country engage in unprotected sex, according to Reproductive Health Study (2003). While a lack of sex education is \"blamed\" for many teen pregnancies in Kenya, traditions that inhibit discussions between parents and children about sex also play a role, AFP/Yahoo! News reports. Conservative religious beliefs and attitudes also play a role!

Religion Teaches Forgiveness; Some Wrongs Are Hard to Forget!

Sasi has been God fearing all her life. She has been taught by her guardians that sex is evil and the young ones should not indulge in it. What she didn’t know was that some very religious teachings do not hold the perpetrators of sexual violence to blame. They are free to rob the young ones of their dignity by silencing them with fear, threats of revenge or even murder should they reveal that they were defiled. Sasi mumbles, “I didn’t know who to turn to when the man hurt me’’.
According to some beliefs, there are no small or big sins, all are equal. Thus there is no blame. But who is to blame when there is an increasing number of pedophiles and sexual abusers roaming in the neighborhoods and defiling our children? Until now the culprit who defiled Sasi is walking free and may believe he is blameless. The silence is deafening.
It is folly to speak of contraceptives in the religious context; the doctrines provide that sex is a holy gift and should be only for the married! What arrogance when the world is full of orphans, who have been robbed of their parents by HIV/AIDS. In addition, religions that have suppressed the \"openness in matters of sexuality\" have also contributed to the teen pregnancy rate in Kenya. Advocating open dialogue, Kang’ara of Egerton University said, \"Churches are institutions of social change and should be in the first line to address these issues\" (Peytermann, AFP/Yahoo! News, 7/10).

Emergency Contraceptive (EP) Is Big Business!

A spot check on 10 village pharmacies within Kibera shows that the real owners are absent and are run by workers with midlevel or little training at all in pharmacology. Even though these workers are alleged to have licenses, on further inquiry it is business as usual of dispensing drugs over the counter. A report from UNICEF in 2012 indicated a case study that was done in Kenya as having health services in Nairobi slums limited and out of 503 health facilities available, only 6 were public. Hence the mushrooming of illegal health clinics that offer substandard care, including poor reproductive health services to the youth. The buying of over the counter drugs is so common, such that the Emergency Contraceptive (EP) can obtained by any youngster. However due to the poverty levels, sometimes buying the pills is not easy. Sasi is an example of the younger generation with little information on reproductive health. There was little or no room at all to discuss this with her family members. One lady owner of a chemist points out, “I normally charge slightly higher than a public clinic for the contraceptives because I buy them, so I can’t give them for free’’.

The Pharmacy and Poisons Board in Kenya has one of the best guidelines for controlling counterfeit and illegal transacting of drugs. However it appears to be only in books as the mushrooming number of bogus pharmacies continues to dot the urban slums. In only one of the 9 villages of Kibera there are numerous chemists not fully recognized by the Board. Citizens who cannot differentiate between a genuine pharmacist and the uncertified may be oblivious of the danger it poses. A pharmacist asserts, “EP is big business. It is popular with the students especially on Friday to Monday. You can’t deny them even though they look so naïve’’.

Access to contraceptives by urban youth has challenges. The majority of the drop outs in the slums regret not having been well informed by their elders about the right to use the contraceptives or how to use them effectively. It was not encouraged for youth to attempt to raise the subject of contraceptives. Often contraceptive use is still held with suspicion and moral disapproval. Thus youth may hesitate to admit using contraceptives. With this in mind the youth end up in hiding and often miss accurate information, counseling and guidance on sex education. This complex subject has been left to classroom teachers who are overwhelmed with school curricula and end up giving random and perhaps incorrect bits of information to fulfill the education system requirement.

The health Institutions are not faring well enough. The initiating of youth friendly clinics seemed a noble step towards reaching to our youths, in reduction of unintended pregnancies and sexually transmitted illnesses. The Kenya Health Survey of 2010 showed that only 7% of health facilities in the country can offer youth friendly services. Also the studies conducted by the Division of Reproductive Health showed that the competency of health providers at these facilities in provision of reproductive health was in dire need of improvement. Other health workers cited moral reservations, religious values and cultural considerations that reduced the utilization and efficacy of these services.

Hope Is Here Again for the Youth and Adolescents

Since this generation constitutes a huge percentage of the population there are hopeful and meaningful interventions coming up. Family Health International (FHI360) , an international organization, in partnership with the Division of Reproductive Health, have currently introduced text messages by mobile phones where the public can access information on maternal and reproductive health. There is a peer education programme that is being strengthened by the Family Health Options Kenya in view of reducing cases of unintended pregnancies and sexually transmitted illness. Their approach is very crucial in that during the August school holidays they bring together youths all over the country to have a one week long camp that addresses reproductive health and sexuality.

On the other hand the Ministry of Health is increasing access of the services to the youth by employing more nurses to address the unmet reproductive health needs. I see twitter as the next big thing to link the youth and nurses in addressing their reproductive health issues.Safaricom is a mobile company in Kenya that has reduced the price of text messages so that majority of Kenyans can tweet. An average urban slum youth has an access to a guardian’s phone or a community phone. The youth require a friendly environment where they can explore issues on gender and sexuality.

Sasi’s One Best Wish

Sasi speaks of her determination to bring up the baby with the help of a foster mother. Her one best wish is to train as a hair dresser or tailor. With $ 150 dollars, she would be able to undergo a 6 months course and become independent. I hope her wish will come true one day. On an optimistic note she wants her son to grow to be the governor of Kibera, so that he protects the girl child from sexual violence. With the support and example of women like Amimo, Sasi may become an advocate for youth at risk. She is in a unique position to reflect on her experience and draw lessons to be shared with her peers and eventually with her son. She has a message to share if she only has the opportunity to find her voice.

This article is part of a writing assignment for Voices of Our Future, a program of World Pulse that provides rigorous new media and citizen journalism training for grassroots women leaders. World Pulse lifts and unites the voices of women from some of the most unheard regions of the world.