Why doctors should tell teens about contraceptives

Failure by health care personnel to discuss contraception with young people who are just about to start engaging in sexual activity potentially increases unwanted pregnancies and abortions. 

This is according to a report on young voices about future scenarios and contraception released in Nairobi on Tuesday.

Grace had her first sexual experience in 2011, when she was 15 years old, with a boy she went to primary school with. "He was my classmate and he taught me how to kiss and perform oral sex, but we never had intercourse," she said.

Before her experience with him, the only thing she knew about sex was what she would discuss with her friends or rumours she had heard in school.

"It was a taboo for us to talk about sex, but when we joined class six, we started getting curious because our bodies were changing and we didn't know who exactly to go to without being embarrassed about it. So we talked to each other," she said.

Soon after, her classmates began getting into relationships with each other and some of them began to explore. However, the girls who were rumored to have had any kind of sexual activity in school were 'bad'.

"We knew sex was bad and it made you have children and drop out of school. That is what our parents told us, and so when a rumor started that someone in the school had done anything with a boy, everybody talked about them in a negative way," she said.

She did not explore any sexual activity until she was done with primary school and started meeting with some of her classmates outside school.

"It started when our parents would go to work and we would visit each other. We started experimenting with alcohol and then started playing games like truth and dare, which would mean some of us got to kiss," she said.

The more they met, the more they experimented, and eventually some had developed sexual relationships with each other. Grace met up with her classmate a few more times until she found out he was doing the same thing with other girls and stopped seeing him.

CONTRACEPTION MESSAGING

Despite an increased prevalence in access to healthcare through increased investment in health facilities, mobile clinics and community health workers, there are numerous missed opportunities to discuss contraception to young people aged 15-19 by health personnel.

A survey done in Nairobi and Bungoma shows only five per cent of young people in that group discussed contraception with health personnel. A larger proportion (92 per cent) did not discuss contraception with either a field health worker or at a health facility. 

"The implication of this is that contraception messaging and provision is being left too late and potentially increasing unwanted pregnancies and other avoidable health outcomes," reads the report. 

Hadassah had her first conversation with a health professional on contraceptives when she was 21 and pregnant. She had visited Marie Stopes clinic in Kisumu to confirm her pregnancy results. 

"They asked me what kind of contraception I used and I did not have an answer. I would have sex, check my calendar to see if my ovulation dates were close, and then based on that, take a pill or wing it," she said. "I found out about pills when an ex and I had a pregnancy scare."

The report says there is considerably low use of contraceptives among those without children. Contraception awareness increases sharply after the birth of the first child.

"Taking the case of married women across the country, there is a reported 15 per cent use of contraception methods, with this figure rising as the number of children increases," reads the report. 

According to the 2014 Kenya Health Demographic Health Survey, 61.4 per cent of women with 1-2 children use contraception, with the number rising to  65.9 per cent among women with 3-4 children. 

This is attributed to contraception information and methods being more accessible to mothers after delivery and moral and socio-cultural perceptions that frown upon sexual activity and contraception outside marriage.

REPAIRING ABORTION DAMAGE

While Kenya may have in place measures to ensure access to contraception information and methods for all who need it, numerous factors point to a different reality on the ground.

There are disparities in access and low contraceptive prevalence rate among those who need it. These include young adolescents (15-19), unmarried women and women without children. 

According to the report, some women with unplanned pregnancies have sought abortion services, sometimes from unskilled practitioners, because it is illegal in the country, unless in the opinion of a trained expert. 

"As such, Kenya finds itself facing a maternal health crisis that has seen the country lose seven women a day (2,600 annually) to unsafe abortions," reads the report. 

According to Africa Population and Health Research Centre, Kenya spent Sh500 million in the treatment of complications arising from unsafe abortions. 

When Hadassah confirmed she was pregnant, she inquired on the price of receiving a safe abortion. 

"It was about Sh5,500 at the clinic and I could not afford it. I had a friend get complications after seeing a quack doctor, so I decided to take my chances with a medical student," she said. 

He charged her Sh2,000 and gave her pills, with instructions on how to take them. 

"I bled throughout that night but after that, apart from cramps, I did not have any major complications," she said.  

The report identifies a gap in interventions on abortions, such as tackling the root causes of unsafe abortion in the country or by expanding the conversation around contraception information and choices. 

On maternal deaths, a policy brief from the National Council for Population and Development on Reducing maternal deaths in Kenya, 2015, shows Kenya records an estimated 6,300 maternal deaths each year during pregnancy and childbirth. 

It identifies unplanned pregnancies as a major contributing factor to maternal deaths. 

"When women and their partners have unfettered access to contraception services, the socioeconomic benefits accrue to their families, communities and the entire nation," reads the report. 

Investment in contraception has also been shown to lead to savings in the cost of healthcare services by reducing pregnancy-related injuries and deaths, while also reducing the burden of public amenities, such as health, water and sanitation. 

CONTROLLED DEVELOPMENT 

According to the report, key achievements of the Big Four Agenda may be in jeopardy if contraception, one of the key pillars of development, remains an afterthought.

Further, the country's population growth rate remains beyond its resources. There is a need to ensure it is consistent with the country's socio-economic development, gender equality and health systems.

According to the latest figures by the Kenya National Bureau of Statistics, the country's population is estimated to be about 47.5 million. The estimated growth rate between 2009-19 is 2.5 per cent.

"It is based on the recognition of the importance of contraception that we have in place legislative provisions to enable access methods and information about contraception," reads the report. 

The Constitution guarantees the right to the highest standard of reproductive health, while the Health Act of 2017 guarantees every adult Kenyan the right to safe, effective, affordable and acceptable family planning services. 

“Based on our approach to population needs, right from the individual and household level, we stand at a crossroads," leading futures consultant Katindi Njonjo said. 

"But with a chance at a better future for our country in 10 years’ time, depending on how we look at the issue of contraception.”