Testing schoolgirls for pregnancy not likely to cut number of teenage mothers

N’gombeni High School principal Cornelius Maganga makes no secret of the fact that teenage mothers are not welcome at his school.

He tells of one student who hid her pregnancy and went home to deliver. “When she came back we told her to look for another place,” he says.

Just an hour’s drive across Kwale District, principal Phyllis Mwachiti has created an atmosphere of respect and belonging at Kichakasimba Secondary School.

“We do not lose girls because we do not chase them away,” she says. “It is always very good if in the school the policy is not sending (pregnant students) home.”

The views of Ms Mwachiti and Mr Maganga, and all those in between, could play out in the private lives of female students if a new health policy aimed at reducing teen pregnancy is put into practice.

The National School Health Policy 2009, under the section on teenage pregnancy, states: “Girls will undergo voluntary medical screening once per term.” But when it comes to teen sexuality in Kenya, how voluntary is “voluntary”?

Social taboos

In a society with strong religious and social taboos against teen sex, where youths lack access to contraception and sex education, leaving interpretation of such a policy up to individual teachers is a potential minefield — giving schools power over a private, moral issue.

“That very easily turns into ‘must’,” says Geoffrey Maganya, a policy developer at Kenyan child’s rights organization, The Cradle. “Schools are places where teachers have absolute power over children.”

The National School Health Policy 2009 is the first of its kind. As such, says Dr Anna Wamai, head of adolescent and child services at the Public Health Ministry, it was designed to take all aspects of children’s and adolescents’ health into consideration.

Research by the Forum for African Women Educationalists (FAWE) suggests that 13,000 Kenyan girls drop out of school due to pregnancy each year. That’s nearly a third of the number of female dropouts. Teenage pregnancy is seen as a major threat to girls’ education, hence the addition of the twice-yearly testing.

“We wanted a comprehensive policy,” Dr Wamai explains. “We are looking at the whole child.”

The policy is still being fine-tuned, she adds, and the ministries still haven’t decided whether parents would be able to opt out of the test on their daughters’ behalf or whether the decision would be entirely up to the student.

The Ministry of Education has always required a pregnancy test for girls as part of the medical exam all students pass before entering Form One.

Parents pay for the exam and present the doctor’s certificate to the school. But with the new school health policy, these tests will be required throughout a student’s academic career.

Signals are conflicting even from the ministries themselves, as to the meaning of the word voluntary.

“Unfortunately, those who will not volunteer are probably those who know they are pregnant,” says Dr Wamai, acknowledging the contradiction with the policy’s wording.

“Because it is a new thing, I think it is good to start with voluntary,” she says, implying that eventually the tests will be mandatory.

“It’s not a voluntary test,” says Ministry of Education official Barnett Walema, a policy developer with the department of school health and nutrition.

Walema says individual teachers will be responsible for implementing the policy and deciding how tests are.

She and Dr Wamai both mention teachers will have the discretion to send girls for testing if they “suspect” the student is pregnant. Suspicious clues would include girls sleeping in class, being choosy about food or vomiting, says Ms Walema.

Teenage girls at several secondary schools the Nation toured in Kwale District insist they would volunteer for such a test.

“It would be better for us because some girls are going to clubs every weekend and they could be getting pregnant,” says 17-year-old N’gombeni student Myuma Shaban.

But at Waa Girls in northern Kwale District, Munira Said, 18, says many girls would be embarrassed to take the test.

“If I knew there will be a test after every term I would be fearing,” she says.

Pinch breasts

And she would not be alone. Indeed, many anecdotes from older women describe situations that would be downright scary for teenage girls. They tell of school nurses in decades past who’d lime girls up, and then pinch their breasts to determine whether they were pregnant.

Kenyan attitudes towards teen sex would prevent many girls from volunteering for the test, adds Dr Regina Karega, the head of Kenya’s National Commission on Gender and Development.

“If the schools expect girls to come and say ‘I had sex so let me check if I’m pregnant’ they won’t,” says Dr Karega, who adds the tests need to be administered in a “friendly” way.

Dr Sanjiv Kumar, the chief of health at Unicef Kenya, says the organisation is still reviewing the policy. But, he says, “gaps in implementation” could lead to a violation of girls’ rights such as the right to privacy and the right to security of person.

In the event of a positive test result, teachers are to inform the girl’s parents. They will then counsel the girl and her parents. Finally, teachers are supposed to find out who fathered the baby.

“It’s actually the duty of the teacher to try and talk to the girl, not in a harsh way, to try and find out what happened and who the father is because it could be an adult,” says Ms Walema.

If the father turns out to be an adult, the school principal is supposed to call the police and child protection officers. If it is a classmate, the boy will get counselling.

Dr Wamai says counselling should include a “re-emphasis on life skills,” which she explains as abstinence education. The boy will also be treated for stress and coached in parenting.

The school is then supposed to ensure the girl seeks four antenatal visits to the doctor. After she goes home to deliver, the student has a choice to come back to the same school or go to a different one.

The various steps between testing and getting a girl back into school are all at the discretion of individual teachers and principals, explains Ms Walema. The Ministries of Public Health and Education are planning a training session within the coming months for all provincial education officers.

It will then be up to the provincial officials to train the district education officers, who will in turn approach the teachers and principals.

This chain of command leaves quite a bit of space between the intentions of the policy developers and teachers’ interpretations. What is written in the policy may not reflect how things will work on the ground in schools.

One problem lies with the negative social attitudes towards teen pregnancy within families and schools. Returning to school after giving birth is often stressful for a girl.

“She is psychologically affected. Other students start calling her mama. She loses attention and ends up dropping out,” says N’gombeni Principal Maganga.

The boys at N’gombeni High admit they have friends who had made classmates pregnant. They add sometimes the boy drops out of school.
“He has to take care of the girl and the child,” says Salim Kilalu, 18.

The policy has not yet been rolled out in Kenya’s schools because the ministries of public health and education are still deciding, among other details, how to pay for the tests.

The two ministries are developing the “school strategy and implementation plan” for the entire National School Health Policy 2009, says Dr Wamai.

The Cradle’s Mr Manyaga is not optimistic. “This country is big on rhetoric that doesn’t lead to action,” he says.

But few object to the idea behind the policy. When Public Health Minister Beth Mugo announced the move in August, she called early pregnancy and marriage the greatest threat to girls’ education.

According to information from the 2003 Demographic and Health survey, about 23 per cent of Kenyan girls aged 15-19 are or have been pregnant.

In a study published in the International Journal of Adolescent Medical Health in 2003, three researchers from the African Population and Health Research Centre found 45.9 per cent of teens aged 12-19 had had sex in the past and of those, 42.8 per cent had been pregnant at least once.

The Nation was unable to find statistics linking teen pregnancy with school drop out rates.

“Many of them stop going to school,” says Kenyatta University’s Mildred Loriaga. “Many of them get married and they don’t go back to school.”

Ms Loriaga did her PhD on teen pregnancy. She says the age of sexual initiation is decreasing. Of the students she interviewed, 95 per cent were sexually active by the age of 19.

Some children are becoming sexually active as early as 10. These children suffer from lack of information about their sexual health, she adds.

The Kenya National Association of Parents is calling for sex education in schools, instead of pregnancy testing, to decrease teen pregnancy.

“As an association we think that (policy) is a very bad move,” says secretary general Ndundu Musau. “We need to introduce sex education at an early age because right now there is no sex education.”

But, he says, parents have a role to play as well. In the past, it was the grandparents’ responsibility to educate children about sexuality. But now, most families avoid the subject.

Religious organisations have expressed doubts about the policy. The National Council of Churches of Kenya is recommending sexual education, as the policy could be “agonising” for girls, says secretary-general Rev. Peter Karanja.

“Considering the challenges that Kenyans face in regards to teen pregnancy, it is important to engage the whole question of family life education,” he says, so children have the information they need to make the right decisions regarding their sexual health.

“Pregnancy testing may not necessarily reduce teen pregnancy, but the information will help different service providers ensure health of the mother and the child are not affected.”

Adan Wachu, the secretary-general of the Supreme Council of Kenya Muslims, says Muslim girls should not even be asked to take a pregnancy test.

“Girls going for tests mean we are alluding to the (sexual) act,” he says. Islam strictly forbids sex before marriage and by introducing pregnancy testing at schools, educational institutions are taking responsibility for a moral issue, he says.

“The intention is good if the intention is stopping teen pregnancy. But maybe they need to ask the right question,” says Mr Maganya of The Cradle.

And that question, he says, is “Why are girls getting pregnant?” The answer? “Because they are having unprotected sex.”

“I don’t see us starting to give contraceptives at school in the near future,” says Dr Wamai. But she says contraception is currently available for all at health centres. According to Kwale District students, those facilities intimidate most young people. Faiza Nassis, 17, of Kichakasimba describes the typical reception young people get from clinic staff: “You’re still at a tender age. What are you asking for that for?”

Dr Wamai says the Public Health ministry is trying to set up “youth-friendly” clinics to combat the problem. So far there are only a few.

But even if there were hundreds of such clinics, a simple truth remains. Biological realities mixed with powerful societal and cultural imperatives seem to suggest that it may be years before Kenyan teens would feel comfortable enough to seek this information on their own. But one other thing is clear.

“Many people are having sex. There is no one who wants to abstain,” says 17-year-old N’gombeni student Mwabweni Mohammed.

The pregnancy testing policy, although aimed at protecting girls, may end up contributing to their vulnerable status within society and sexual relationships.

Already underperforming compared to boys in school, at risk of early pregnancy and being forced into early marriage, being coerced into sex for food or matatu rides, girls have so little power in many aspects of their lives.

These tests might be just one more of those things girls won’t have control over.

THURSDAY: The consequences of wishing away widespread homosexuality in Kenya