The moral and social narratives of sexual and reproductive health in Kenya: a case of adolescents and young people pre- and within the MDG era

Abstract

Background: The role of global initiatives in catalyzing change within national contexts is complex and less understood. Addressing adolescent sexual and reproductive health in Kenya requires concerted efforts of both state and non-state actors and more importantly, a supportive environment. This paper deconstructs the moral and social narratives of adolescents' and young people's sexual and reproductive health (AYSRH) in Kenya as driven by the powerful discourse and ideologies pre-and within the Millennium Development Goal (MDG) era. Methods: Literature was systematically searched in PubMed and Medline with policy documents obtained from government agencies from the pre-MDG period (2000 and earlier) and within the MDG period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). Literature with a substantial focus on SRH were eligible if they captured the different facets of ASRH in Kenya and sub-Saharan Africa (SSA). The results were reviewed and synthesized to disentangle the moral and social narratives of AYSRH in Kenya with an MDG lens. Results: The evolution of AYSRH policies and programmes in Kenya was gradual and largely shaped by prevailing development threats and moral and social narratives. Pre-MDG period was dominated by issue-based policies of population growth and high fertility rates, with a focus on married population with strong cultural and religious barriers to AYSRH; early to mid-MDG was mainly influenced by the threat of HIV/AIDS, culminating in the first Adolescent Reproductive Health and Development Policy in 2003. However, the policies and subsequent programmes focused on abstinence only and medical narratives, with persistent religious and cultural opposition to AYSRH. Late-MDG saw more progressive policies (these are policies that refer to those that tends towards acceptance of liberal social reforms and which sometimes are contrary to entrenched social norms, beliefs and practices), high government commitment and a refocus on SRH issues due to sustained early childbearing, culminating in the revised Adolescent Sexual and Reproductive Health Policy of 2015.

“We Don't Fear HIV. We Just Fear Walking around Pregnant.”: A Qualitative Analysis of Adolescent Sexuality and Pregnancy Stigma in Informal Settlements in Kisumu, Kenya

“…The fear of pregnancy among adolescents in Kisumu is driven primarily by fears that their community will discover their sexual activity. Our findings build upon previous research examining social stigma of adolescent SRH by adding nuance to the intensity of the fear and how it affects behaviors, with sometimes fatal consequences (Moseson et al 2019;Smith et al 2017;Rice et al 2018;Kaljee et al 2007;Akwara and Idele 2020;Hall et al 2018;Levandowski et al 2012). Inclusion of perspectives from boys and the FGD format where social norms were intentionally explored provides new insights on SRH stigma and the focus on abortion and suicide prevalence are novel insights.…”

“…Globally, 10 percent of all births are to girls and young women under 20 and more than 90 percent of these births occur in low‐ and middle income countries (World Health Organization 2017; Mayor 2004). In Kenya, as in other sub‐Saharan African countries, adolescent pregnancy rates are high, contraception utilization is low, and adolescent sexuality is socially stigmatized (Akwara and Idele 2020; Kenya National Bureau of Statistics, Ministry of Health/Kenya, National AIDS Council/Kenya, Kenya Medical Research Institute, and National Council for Population and Development/Kenya 2015). Among respondents aged 20–49 of the 2014 Kenya Demographic and Health Survey (DHS) in Kisumu County, in the western region of Kenya, the median age of sexual debut was 16.4 for women and 17.9 for men.…”

“…Social, cultural, and religious taboos lead to a lack of sexual and reproductive health (SRH) dialogue between adolescents and their parents, teachers, and clinicians, with 92 percent of adolescents in Kenya reporting that they had never discussed family planning with a health care worker (Kenya National Bureau of Statistics, Ministry of Health/Kenya, National AIDS Council/Kenya, Kenya Medical Research Institute, and National Council for Population and Development/Kenya 2015; Hagey et al. 2015; Akwara and Idele 2020; Mitchell, Jonas‐Simpson, and Ivonoffski 2006; Jayaweera et al. 2018).…”

“…Despite the high prevalence of adolescent sexual activity in Kisumu County, contraception is highly stigmatized and underutilized, with 50 percent of sexually active unmarried adolescents reporting no method used (Kenya National Bureau of Statistics, Ministry of Health/Kenya, National AIDS Council/Kenya, Kenya Medical Research Institute, and National Council for Population and Development/Kenya 2015). Social, cultural, and religious taboos lead to a lack of sexual and reproductive health (SRH) dialogue between adolescents and their parents, teachers, and clinicians, with 92 percent of adolescents in Kenya reporting that they had never discussed family planning with a health care worker (Kenya National Bureau of Statistics, Ministry of Health/Kenya, National AIDS Council/Kenya, Kenya Medical Research Institute, and National Council for Population and Development/Kenya 2015; Hagey et al 2015;Akwara and Idele 2020;Mitchell, Jonas-Simpson, and Ivonoffski 2006;Jayaweera et al 2018). A recent survey of teachers and peer-counselors in Kisumu found that one-third of respondents believed contraceptives cause infertility, encouraged promiscuity, and that adolescent girls cannot make their own decisions about use, highlighting the limited access adolescents in the region have to evidence-informed counsel (Håkansson et al 2020).…”

Access to information and use of adolescent sexual reproductive health services: Qualitative exploration of barriers and facilitators in Kisumu and Kakamega, Kenya

“…While the World Health Organization (WHO) classifies adolescents as those aged 10-19-year-old, our study focused on 15-19-year-olds because adolescents aged 10-14 are considered very young and interventions targeting this group were likely to be met with resistance by county governments and stakeholders. In Kenya, strong cultural and religious narratives have been instrumental in blocking implementation of ASRH interventions outlined in global commitments [16]. In addition, this study was a formative assessment for an intervention study designed to use a community, facility, and school approach and the school approach was designed to target secondary schools, which enroll adolescents above 14 years.…”