Addressing the Family Planning Needs of Adolescent Girls and Young Women

Tucked away on a dusty road in the informal settlements of Eastern Nairobi, you’ll find the Lunga Lunga Youth Friendly Center. A modest cement building with a corrugated tin roof, the inside is plastered with colorful posters promoting free post-rape care and the importance of protecting yourself from HIV and STIs. It is managed by U-TENA (Kiswahili for re-uniting), a grassroots youth organization with a mission of educating communities about sexual and reproductive health (SRH).

In September, I traveled with a small delegation from CSIS to look at reproductive health and family planning in Kenya, and met with a group of young women at Lunga Lunga to hear about life in Nairobi’s informal settlements. We gathered our plastic chairs in a circle, which grew as more and more women trickled into the meeting. A number brought their young children, some old enough to wander around the room, others swaddled in blankets. The women, mostly in their late teens and twenties, were well-versed in the language of empowerment and in the importance of having control over one’s reproductive health. One young woman explained, “Family planning worked for me. I wanted to go out and do something…it sets me free because I can decide how many kids I have.”

U-TENA has a variety of programs, from health education through theater and dance to income generation and life skills training. The common feature is that all projects focus on the SRH needs of adolescents, who represent over a quarter of Kenya’s population. While we heard that family planning should not just be a woman’s responsibility, it is clear that young women face disproportionate challenges. In Kenya, teenage girls have the highest unmet need for family planning among all women of reproductive age and contribute to nearly 1 in 3 maternal deaths. Adolescent girls are four times more likely to contract HIV than their male counterparts, and nearly half of teenage pregnancies are unintended.

The women we met with represented a number of different groups under the U-TENA umbrella, including the Kuza Project, which focuses on delaying age of sexual debut through work with older female mentors, and Hope Creations, which provides income generating opportunities by teaching women beading and sewing. The Tupange program, funded by the Bill & Melinda Gates Foundation, had partnered to provide family planning information and services and promote SRH through outreach days. The group outlined several factors that keep young women from accessing family planning. There are misconceptions that family planning is for older or married women, despite that many adolescent girls are sexually active. Teenage girls do not want to go to the same health centers as older women, where they feel judged by public healthcare providers, and turn instead to private pharmacies, where services are of variable quality. There are not enough young community health workers to speak with, and not enough young males involved in family planning activities. Youth friendly centers often cater more to boys, who are interested in hanging out and playing games.

While these challenges are not unique to Kenya’s informal settlements, they are certainly amplified by a lack of economic opportunities in the slums. Lunga Lunga is located near Nairobi’s industrial district, where many work as day laborers in factories or selling food on the roadside. Jobs are often hard to come by, which means that young women rely on boyfriends to buy basic things, even sanitary pads. Often the men expect sex in return: “if you’re a single mother making ends meet, an older man will take advantage of you.” The ensuing paradox described by one woman is that “most men refuse family planning, but still don’t want you to get pregnant.” It is typical for women to hide contraceptive use from their partners, one factor that has made injectable contraceptives the method of choice.

Kenya’s recently released National Adolescent Sexual and Reproductive Health Policy aims to mainstream the SRH needs of young people into health and development programming, providing guidance on youth-friendly services and highlighting the government’s commitment to providing comprehensive sexuality education. But there is a wide gap between policy and reality. The failure to meet the needs of young women in the classroom and clinic necessitates a more flexible approach, one that programs like U-TENA work to provide through the creation of safe spaces, peer groups, and innovative outreach programs, as well as highlighting the connections between family planning and economic empowerment.

One of the group leaders, Shiko, made it clear that it is not easy being a single mother. But it was also clear that she has major ambitions for herself and her son (“he’s 4 years 8 months and 7 days” she said with a smile), as she works towards a university diploma in psychology counseling. She explained that family planning is key to empowering women, because “in Africa, when you give birth to a child, the owner is the mom.” If a woman is able to control when she has children and earn a living, it will improve not only her situation, but that of her community as well. The women had hopes that one day their children would be educated, they would feel safe walking around at night, and that poverty would eventually be eliminated from Kenya. And as they described, at the heart of all these hopes is family planning.