Tough choices: I put my daughter on contraceptives, but don't judge me

“I am not going to sit down and wait for my daughter to come with a protruding stomach, yet I know there is a way to prevent it,” Mr Ondieki*, a resident of Trans Mara in Narok County, and father of three daughter says resolutely.

All of them are on birth control. It began when his firstborn gave birth at the age of 14, while in Standard Seven. Before then, she spent many nights out, pretending to be attending preps at school.

“Everyone talked about my promiscuous daughter. It was very embarrassing, and not only that, I am struggling to find money for school fees. I don’t need the added burden and responsibility.

“ How do I take care of my daughters and their babies? I don’t have the resources,” he explains his decision to put his daughters on birth control.

His eldest still spends night outs, pretending to be at a friend’s place.

“I know she is still sexually active. It was within my power to keep her and her sisters from pregnancy, but I’m worried she could get infected,” he says with a resigned sigh.

“We can’t pretend that teaching them abstinence is working. They are seeing so much on social media and they put it into practice, even though they are still too young for sex.

“The current generation cannot wait for the right time to engage in sex. You tell them to use a condom, for precaution, but you can’t be sure that they are,” he adds, and says that his other two daughters were put on birth control as soon as they got to Standard Seven.

His youngest – the lastborn – has been on Depo-Provera (the three-month contraceptive injection) for the last one year. The girls get their shots just before the school term starts.

Mr Ondieki’s is a dilemma, faced by many parents in Narok County, which has the highest rates of teenage pregnancy in the country.

The teenage pregnancy rate stands at 41 per cent, more than double the national prevalence of 18 per cent, according to figures from the Kenya Demographic Health Survey of 2014. In Narok, nearly half the girls trade playtime and school time with nursing babies.

Last year, 672 girls 10 to 14 years and 10,189 girls aged 15 to 19 years got pregnant.

Between January and June this year, 344 pregnancies were recorded among 10- to 14-year-olds, while 6,935 pregnancies were recorded among 15- to 19-year-olds.

Other counties with high rates of teenage pregnancy are Homa Bay (33 per cent), West Pokot (29 per cent), Tana River (28 per cent), Nyamira (28 per cent) and Samburu (26 per cent).

Countrywide, some 378,397 girls aged 10 to 19 years became pregnant between July 2016 and June this year.

To rein in the high rates of teenage pregnancy, parents, some of whom don’t believe in using contraceptives, because they fear it interferes with fertility, have resorted to putting their daughters on birth control.

In many cases, this happens after the first daughter gets pregnant. She is put on birth control immediately, and so are any younger sisters, as soon as they begin to show signs of puberty.

While some parents take the matter into their own hands, herding their girls to the nearest provider for birth control, some girls, like 14-year-old Maureen*, seek the services without the knowledge of their parents.

While her classmates rush out to play during break time, the Standard Six pupil, heads home to breastfeed her two-and-a-half-year-old toddler.

Her pullover is soaked in milk and her full breasts are in pain. The father of her child is a boy in Standard Seven.

They used to meet every evening after preps to have sex, then in October 2015, she got pregnant. When it became evident that she was expectant, her father chased her and her mother away, and they sought refuge at her uncle’s homestead.

She’s back to school now, but she doesn’t want to get pregnant again. Her friends told her that she could use birth control to prevent pregnancy.

“To be honest, I am still sexually-active, but I don’t want to bring shame to my family again. My mother lost her home because of my pregnancy. I also don’t want my studies to be interrupted by pregnancy. I have been using the Jadelle implant, which will protect me for five years, but my mother doesn’t know about it. I will use it until I complete my education,” she says. Maureen is among the 125 girls aged 10 to 14 years who were on contraceptives between January and June this year.

A further 2,693 girls aged 15 to 19 years were also on birth control, during the same period, according to county statistics.

UNPROTECTED SEX

The National Adolescent Sexual Reproductive Health Policy of 2015, estimates that 37 per cent of girls and 44 per cent of boys aged 15 to 19 years have already started having sex, and 18 per cent of girls in that age group have already begun childbearing.

It estimates that 13,000 girls drop out of school every year due to early and unintended pregnancy, and that one in three adolescent girls have an unmet need for family planning.
This means that they are having unprotected sex and are likely to get pregnant, but are not using birth control, even if they report not being ready for babies at the time.

To prevent these pregnancies, the policy recommends the promotion of accurate information and services on contraceptive methods to meet the diverse needs of adolescents.

Kenya made a commitment to reduce teenage pregnancy by 16 per cent by 2020. This would mean ensuring that at least 120 more million girls and women of childbearing age, get access to contraceptives to prevent unintended pregnancy.

CHAMPIONING FAMILY PLANNING

In Narok, Sarah Tanui, the governor’s wife, and a family planning champion, is leading the campaign against teenage pregnancy.

“The moment a girl gets her first pregnancy, it is very easy to get the second one. To prevent this, we have been providing girls with family planning, but only after a check-up by a medical doctor, who advises on the method best suited for the girl,” she says, arguing that girls who are already sexually-active are no longer in the bracket of children to be told to abstain. Instead, they should be advised to use protection if they engage in intercourse.

Mrs Tanui adds that the county has put into place measures to reduce the number of teen pregnancies and retain girls in school.

Through aggressive campaigns, the county has reached 3,000 young people with contraceptive information and services.

“When I received a report that my county was leading (in teenage pregnancy), I was very concerned. I sensitised political and religious leaders, and formed a technical working group to address the issue and the reason behind the numbers.

“I want to ensure that girls are spared early pregnancy and those who do get pregnant go back to class, so that they can make something of themselves and contribute to the county’s economy in future,” she says, adding that the health and education ministries have come up with a plan that was approved by the county assembly in May.

CONTRACEPTIVES PROGRAMMES

Female members of the county assembly are also pushing for allocation of money to contraceptive programmes as a way to tackle teenage pregnancy.
There are those who don’t see contraceptives for teens as a solution.

“I am not going to allow my child to use family planning. I have never used it and I would not encourage her to start using it now,” says Margaret*, who believes that putting a teenager on contraceptives means that she has given permission for her child to have underage sex.

Moreover, she believes that girls who use contraceptives, face difficulties with conceiving, years later when they are finally ready to have babies in adulthood.

“I want my daughter to abstain and concentrate on her studies. It will also keep her from diseases,” she says.

But her daughter, Immaculate*, a Form Four student, is not abstaining.

“Almost every girl in class is on a contraceptive, but I’m afraid if I get one, my mum will find out,” she says. She got her first child in 2015, when she was in Form One. She has since gone back to school and is sitting her final exam this year.

She started having sex at the age of 14, with a boy she had known for six years. He was two years older.

“We met on the way to church. He told me he loved me and he wanted me to be his girlfriend,” she narrates.

Her mother was strict, and that kept them from any mischief. Then when the mother went visiting in the village, Immaculate’s boyfriend told her to prove her love for him.

“That is how I got pregnant. We did it only once,” she says, while playing with her fingers.

She says she didn’t know then that it was possible to get pregnant at the first sexual encounter.

“If I had known, I would have waited. Pregnancy, labour, breastfeeding, the stigma … I didn’t want to go through that again. I try to abstain, even though it is not easy,” says the teenager.

According to Dr John Ong’ech, an obstetrician/gynaecologist at the Kenyatta National Referral Hospital, teenage girls are not fully prepared – physiologically and biologically – for pregnancy.

“They have incomplete pelvic growth and their birth canals are not appropriate for the passage of a baby, so they are more likely to suffer fistula and other complications during childbirth,” he explains.

However, he says that parents should face the reality that teenagers are having sex and give them options to protect themselves.

“We cannot continue burying our heads in the sand. If a teenager is not abstaining, but is empowered with knowledge, there is nothing wrong with giving them contraceptives. In any case, teenagers with heavy and painful periods are often put on the pill, to help relieve the pain,” he says, adding that the only worry is that teenagers are not afraid of getting HIV.

John Mark Koisaba, the secretary general of a council of elders, says that parents need to drop the apathy and stop skirting around the issue when it comes to dealing with early sex and pregnancy, but concedes that rather than have a child get pregnant repeatedly, contraceptives can come in handy.

“In case of repeated pregnancies, they are free to use contraceptives, but only where there is a need,” he says.

Mrs Tanui echoes his thoughts, saying that contraceptives do not absolve parents from responsibility: “Parental responsibility is something we still need to shout from the rooftops. If your daughter is not at home or has gone for a sleepover, we should be very worried because we have no idea what she might be up to,” says Ms Tunai.

In Kisumu, Beatrice Auma, a children’s rights officer, who says that most teen pregnancies are reported during August and December holidays, insists that girls are too young for contraceptives, and abstinence is the only way.

“We need to take care of children by preaching abstinence, because the girls are still in school and too young to be talking about family planning.”

According to Raphael Aoko, a programme unit manager at Plan International, there needs to be continuous efforts to remind girls of the importance of completing their education and to hold off marriage and childbearing until their bodies are fully developed.

*Names have been changed to protect privacy

***

Poverty, defilement and FGM blamed for pregnancies

In a little village in Transmara West, Narok County, a heavily pregnant Imelda, is due to give birth any time now.

The shy 12-year-old girl, dropped out of school in Standard Four earlier this year, after she got pregnant. She is a victim of defilement. Imelda says the man – her father’s age – lured her with lies, gifts and money.

“The first time he touched me and did nothing else … Then one day he sent my friends to tell me that my mother had asked that I pick sugar from his house. When I got in, he closed the door and slept with me. That’s how I got pregnant,” she says.

The only thing that bothers Imelda’s mother, is that her daughter has brought shame to the family, and that she should be put on birth control as soon as she delivers, to keep it from happening again. Prodded further, the family did not want to talk about the man, and whether they had reported the incident of defilement to the police.

Neighbours said that the man had never been arrested. According to Raphael Aoko, a programme unit manager at Plan International, parents and witnesses cover up for perpetrators, and decline to testify, so culprits go scot free.

“Parents are compromised and refuse to tell the truth. They sacrifice girls at the altar of child marriage, denying them a chance to grow up into successful members of society,” he says.

Confounding matters is the outlawed practice of female genital mutilation, which is associated with 90 per cent of early pregnancies, because after the procedure, girls are considered adults, who are ready for marriage and motherhood.

Girls from poor backgrounds are especially vulnerable as they are lured with gifts and money by men who are much older. Moreover, their parents readily marry them off as long as they are offered bride price.

Figures from the Kenya Demographic Health Survey show that teenagers from poor households are more likely to have begun childbearing (26 per cent), than those from wealthier household (10 per cent).To make matters worse, parents appear apathetic.

“Parents do not ask questions when they see their daughters in new clothes and shoes, whose source they do not know. Some are not able to provide basic necessities such as sanitary towels, leaving the girls vulnerable to anyone who can dangle a little bit of money in exchange for sex,” says John Mark Koisaba, the secretary general of a council of elders.

Narok Governor Samuel Ole Tunai, acknowledges that defilement and child marriage contribute to high teenage pregnancy, and has issued a directive for the arrest of perpetrators to act as a deterrent to would-be offenders.

According to Kigen Korir, a programme officer at the United Nations Population Fund (UNFPA), most of the girls drop out of school after pregnancy, denying them the social, economic and health benefits that come with higher levels of education.

“Moreover, girls who get pregnant early are at a higher risk of procuring abortions and suffering abortion-related complications. They also face higher risk of pregnancy-related complications, and maternal mortality and morbidity,” he says.