Finding the Way Forward- Hope for improving Youth Sexual and Reproductive Health Globally

Have your heart and mind ever been so full that you find yourself expending all of your energy on processing thoughts and feelings? That’s where I’ve been the past few days. Full of admiration for the work of my Ipas Africa Alliance colleagues and their beautiful country.

During the second half of last week, I attended a meeting where Ministry of Education (MOE) officials and administrators met with Choice for Change (C4C) program staff (see my last post for a description of that program). The purpose of the meeting was to bring MOE staff up to date on statistics regarding youth sexual and reproductive health (SRH) nationally and in their county, as well as the basics of the C4C program, with the hope that they will encourage teaching staff to refer youth for services as needed. This is essential, as Alliance colleagues explained that some teachers have discouraged their students from accessing contraception through the program due to the stigma around adolescents and sexual activity.

The Africa Alliance’s Health Systems Advisor, Martha Kaguara, began the meeting by asking MOE staff to share their experiences with challenges in youth SRH. The stories they shared were difficult to hear, ranging from a young girl giving birth in a latrine to the expulsion of pregnant youth from school and the lack of consequences for the young men who got them pregnant, and even instances of sexual abuse perpetrated by teachers themselves (teachers have considerable power in many areas of the country, and some abuse this power).

There were several comments that were very stigmatizing toward youth SRH, especially toward girls. But there was also a real desire in the room to find a way to address these issues. When one participant deemed the young woman who gave birth in the latrine as “negligent” other MOE staff immediately responded, essentially stating that it is the community who is negligent when youth are denied access to the information, support and the tools to prevent pregnancy. Martha responded to these heartbreaking stories with a call for action, “Are we all seeing these cases? Are they there? What are we going to do about it? It is not about talking. It must be about the way forward. There were many head nods among attendees.

The way MOE staff became increasingly engaged with the topic throughout the day, and their excitement around collective action to improve the lives of youth in their communities were inspiring. While some for their comments reminded me of the global need to sensitize adults to become true allies, rather than judge and jury when it comes to youth SRH, I was impressed by the patience with which Martha and Moses Kidi, the Africa Alliance Youth Advisor, worked to build compassion for youth facing inadequate SRH information and resources, converting those who may have been foes to allies in this work. It is a privilege to witness this process and learn from it.

One moment that really stuck with me was the challenge to the audience made by Moses regarding our collective responsibility to link youth to services: “There are those of us who have killed clients, sending them away. You don’t know what happened to that girl. Did she seek an unsafe abortion? Did she die? We are all responsible.” The weight of that statement was palpable.

Later, he shared with me how this is a major issue that the Alliance has worked to address within health facilities as well. Facilities may turn away very sick women, and especially those suspected of having induced an abortion, as high rates of maternal death within the facility will cause them to look poorly when mortality audits are conducted by the government. Maternal death due to abortion is not captured in official data, though studies indicate incomplete abortions account for over one-third of gynaecological admissions and unsafe abortion is responsible for approximately 13% of maternal deaths in Kenya (Lema et al, 1996). In Africa- and all over the world, abortion is common. On the continent, over six million abortions are estimated to have occurred in the year 2008, with two million occurring in East Africa alone (World Health Organization, 2011; Singh, S., 2006).

As I reflect on this week, I am in awe of the commitment of my colleagues working on C4C and their determination to ensure every person has access the information and resources to prevent unintended pregnancies. I have been thinking a lot about how, although some issues, like stigma directed at pregnant youth, are global challenges, others are a direct result of oppressive forces throughout history, and the intersection of various forms of oppression. For instance, it seems grossly unjust that, to varying degrees across the globe, women of color, and particularly young black women, are faced with the highest rates of unmet need for contraception, unintended pregnancy and maternal death, including death from unsafe abortion. In Kenya, which gained its’ independence from Britain in 1963 only after much bloodshed, the maternal mortality ratio is about 363 deaths per 100,000 live births (Kenyan Demographic Health Survey, 2015). Many of these deaths are among young women, as are many of those caused by a lack of access to safe abortion. While the U.S. maternal mortality rate is much lower at 28 deaths per 100,000 live births, this rate has risen alarmingly in recent years, and black women in my country are three to four times (or in some states like Louisiana, even five times) more likely than white women to die within one year of giving birth (The Root, 2016). This is not just a matter of health, but also a matter of human rights- and specifically, reproductive rights, as the United Nations and other international organizations have pointed out (UN News Centre, 2015; WHO, 2012).

While women and girls of all colors live with the burden of various types of harm caused by the patriarchy, even if they might choose to deny this reality, far too many women of color are also burdened with the ongoing effects of colonialism and white supremacy. Some are also harmed by homophobia, transphobia and ableism. How can we, as a global SRH and rights movement do a better job of recognizing and pushing back against this- of helping to right these historic wrongs? I think one step is stating them aloud and remaining cognizant of the root causes of these injustices as we engage in this work. All women are created equal, but they are not treated as such by societies. Further, we must ensure that those leading SRH efforts like those of the Ipas Africa Alliance are representative of the communities they seek to influence, and that they genuinely seek to gain the perspectives and direction of the young people they wish to benefit.

If we aim to ensure every person has access to the tools to prevent pregnancy and end a pregnancy safely, we must admit this reality. It must be about the way forward for youth- and for all of us.

Youth SRH Kenya

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