|
African Population Studies
Union for African Population Studies
ISSN: 0850-5780
Vol. 12, Num. 2, 1997
|
African Population Studies/Etude de la Population Africaine, Vol. 12, No.
2, September/septembre 1997
Determinants
of Adolescent Reproductive Problems in Kenya: Evidence from Health Service
Data
Kennedy N. ONDIMU
Department of Geography, Egerton University Njoro, Kenya
Code Number: ep97014
ABSTRACT
Recent studies on adolescent reproductive health in Kenya indicate high incidence
of maternal mortality and morbidity. The medical service records available
for 1,756 women aged 10 to 20 years in seven randomly selected health facilities
were analysed to identify major reproductive health problems of adolescents
in Kenya. Of the total sample, 31.5 per cent had high blood pressure, 29.2
per cent had prepartum and postpartum haemorrhage, 28.6 per cent experienced
obstructed labour, 27.2 per cent had low birth weights and 14.2 per cent of
births delivered to these mothers died. The incidence of these health problems
varied by socio-economic and demographic characteristics of the mothers. Recommendations
to address these problems include encouragement of female education, introduction
of family life education in school curricula, increasing access to ante-natal
services in villages, expansion of free and better equipped referral medical
facilities, provision of family planning services and general socio-economic
reforms in the rural areas.
RÉSUMÉ
Les récentes études sur la santé de la reproduction
chez les adolescentes au Kenya indiquent une forte incidence de la mortalité et
la morbidité maternelles. Les archives du service médical
disponibles pour 1756 femmes âgées de 10 à 20 ans dans
sept formations sanitaires sélectionnées au hasard ont été analysées
pour identifier les principaux problèmes de santé de la reproduction
au Kenya. Sur lensemble de léchantillon, 31,5 % avaient une hypertension
artérielle, 29,2 % avaient une hémorragie avant et après
laccouchement, 28,6% ont connu un travail difficile, 27,2% avaient un enfant
de poids en deçà de la normale à la naissance et 14,2%
des enfants mis au monde par ces femmes sont morts. Lincidence de ces problèmes
de santé a varié suivant les caractéristiques socio-économiques
et démographiques des mères. Au nombre des recommandations
en vue de trouver des solutions à ces problèmes figurent lencouragement à léducation
des femmes, lintroduction de léducation à la vie familiale
dans les programmes scolaires, un plus grand accès aux soins prénataux
dans les villages, le développement dinfrastructures médicales
daccueil gratuites et mieux équipées, laccès aux
services de planification familiale et lapplication de réformes
socio-économiques dans le monde rural.*
INTRODUCTION
Adolescence is a time when great physical, educational and social changes
take place in a person. In the case of girls, it is also the time when most
of them are given out for marriage even before their first experience of menstruation
(Senderowitz and Paxman 1985). Pregnancy among adolescents is a growing health
concern in many African countries (Kulin, 1980). This is because childbearing
has been associated with many social and health risks that are sometimes very
serious, and therefore, need targeting from both the curative and preventive
health strategies. For instance, adolescent child bearing has been identified
to be the major cause of interrupted and discontinued education (Kenya, 1988 ;
AMREF, 1994). Early pregnancies have also been associated with higher than
usual risk of morbidity during child birth and high incidences of maternal
and perinatal deaths (Makinson, 1985; Senderowtiz and Paxman, 1985; Geronimus,
1987 and UN, 1989).
Various reasons have been put forward to account for high incidences of teenage
pregnancies. These include; lack of knowledge on contraceptives (Ajayi et
al., 1991), early marriage accompanied by need to prove ones fertility (Barker
and Rich, 1972) and the erosion of traditional practices coupled with lack
of family control in urban areas (Feyisetan and Pebley, 1989). Pregnancy related
deaths and disabilities are therefore increasingly being seen as a measure
of neglect of the basic needs and rights of women. Meanwhile, as a result
of high fertility and declining mortality, the population of Kenya, which
will reach 30 million by the year 2000, is characterised by a young population.
Over 50 per cent of Kenyas population is less than 15 years of age, 59 per
cent is less than 50 years (Kenya, 1994).
DATA SOURCES AND METHODOLOGY
This study is based on health services data derived from maternity record
and birth notification cards found at seven randomly selected centres that
represent both rural and urban areas. These cards contain vital reproductive
health information on maternal age, birth weight, size and height of the mother,
marital status, parity, education level, nature of birth and place of residence
of mothers. The card also indicates whether or not the mother had been attending
prenatal clinics and the type of personnel consulted for prenatal care. The
records covered one calendar year ending December, 1994.
Health facilities have been found to be the most convenient places to locate
women with complications (Barreto et al, 1992). If the referral system is
working efficiently, most high risk women who present themselves for prenatal
care are referred for hospital delivery. Evidence from the Kenya Demographic
and Health Survey (KDHS) of 1993 indicate that up to 95 per cent of pregnant
women in Kenya receive antenatal care from trained medical practitioners (Kenya,
1993). It was therefore assumed that if any problem is detected, it must be
referred to more specialized personnel for attention. The hospitals that were
selected for this study therefore had a maternity section with wards for in-patients.
This study also considered the fact that the outcome of a pregnancy is not
by chance but is determined by circumstances of a womans life especially
the economic and environmental condition in which she lives as well as her
social status. In order to cater for different socioeconomic, we further subdivided
the hospitals into three categories according to ownership. These are :
government mission and privately owned. The government hospitals enjoy subsidies
in terms of personnel and drugs and they offer free services. Most people
who utilize the government hospitals are therefore assumed to come from low-income
classes. Mission hospitals on the other hand, are supported by religious-based
oriented organizations which require them to charge minimal fees for medical
care. Most people who utilize such facilities come from the middle-income
class. Finally, privately-owned hospitals are managed by individuals or groups
of individuals with a profit motive. They charge high fees for the services
rendered. In total, seven hospitals were selected for data collection; five
from rural areas and two from urban areas. Of these, three were government-owned,
whereas the other two each were run by NGOs and private individuals.
The list of variables that were included in the questionnaire was determined
by the availability of information. Since this was not a prospective survey,
the information recorded was not very detailed. The variables included in
the questionnaire were; place of residence, age of mother, occupation of mother,
marital status, educational level of mother, frequency of use of modern contraceptives,
whether mother visited antenatal clinic, person consulted for antenatal care,
previous obstetric history (i.e. number of births, abortions, complications,
etc.), current obstetric and gynecological situation -i.e. blood pressure,
birth weight, nature of delivery and reproductive health problems experienced
during delivery.
Table 1 : Percentage distribution of study cases by background characteristics
Characteristics |
Percentage |
Residential
Urban
Rural |
64.4
35.6 |
Ownership of Hospital
Government
Mission
Private |
72.2
21.1
6.6 |
Age in Years
10-15
16-20 |
3.0
97.0 |
Occupation
Housewife
Farmer
Formal employment
Business
Student
Barmaid
Housemaid
Other |
41.1
8.0
21.3
8.1
11.2
0.7
1.8
7.8 |
Marital Status
Married
Single
Divorced
Widowed |
60.4
38.8
0.6
0.2 |
Education Level
None
Primary
Secondary Plus |
4.9
55.4
39.7 |
Contraception
Ever used
Never used |
0.4
99.6 |
The data collection exercise took three months, between March and June, 1995.
A total of 1,756 questionnaires were completed. More cases were obtained from
urban hospitals than rural. This may suggest that less rural people utilize
hospitals for delivery care compared with urban counterparts. There is therefore
a need for a separate study to establish factors that lead to low level of
utilization of health facilities for birth deliveries in rural Kenya. Table
1 below shows the percentage distribution of all the respondents by background
characteristics.
From Table 1, it is evident that most people utilize government hospitals
probably because they offer services free of charge. As regards occupation,
most adolescent mothers are not in formal employment, they are either housewives
(41 per cent) or students (11.2 per cent). This shows that most young mothers
lack both the social and economic autonomy to be self-reliant. It is only
21.3 per cent of the respondents who were in formal employment. Over 60 per
cent of the respondents were married which clearly shows that early marriages
are still prevalent in Kenya. About 38.8 per cent are single. More than half
of the respondents had only primary level education; this reflected that they
drop out of school early. Ever use of contraception is very low as evidenced
in Table 1 above. Reasons for non use were not indicated but this could be
due to demand for children amongst married adolescents and to the government
policy that prohibits single adolescents from being given contraceptives.
Earlier studies have however shown that low contraceptive use amongst Kenyan
adolescents is due to negative perceptions that associate contraceptive information
with promiscuity, lack of information, lack of access to services and prohibitive
policies that outlaw accessibility to adolescents (Ajayi et al., 1991;
Njau, 1993 and AMREF, 1994).
Utilization of Antenatal Care
The health of a pregnant mother has been found to significantly compare with
utilization of antenatal care. This is because antenatal care can help to
identify those women who are at risk of complications during pregnancy and
delivery, and thus ensuring that they obtain special attention in suitably
equipped facilities. It also provides an invaluable opportunity to increase
the awareness of women, their families and communities of the risk of pregnancy
and how this can be overcome. The extent of utilization of modern antenatal
clinics and the increase in proportion of mothers who visit trained personnel
for antenatal check up, therefore, indicates the success being made in improving
maternal health. Data obtained from the records indicated the extent to which
mothers had sought ante-natal care during pregnancy and the person consulted.
Tables 2 and 3 show the percentage distribution of all respondents who utilized
antenatal services and the distribution as per the type of personnel contacted
respectively.
From the tables, it will be observed that over 80 per cent of women who delivered
in the hospitals received antenatal care. The majority of them, however, visited
health centres where the personnel consulted most were trained nurses (65.4
per cent) followed by clinical officers (13.4 per cent). Table 4 on the other
hand, shows the distribution of respondents utilizing or not utilizing antenatal
clinics by selected background characteristics.
Table 2: Percentage distribution of the adolescents who visited antenatal
clinic by type of facility
Type of facility |
Percentage |
Dispensary
Health Centre
Hospital
Mobile MCH/FP
TBA
None |
17.1
39.4
12.2
12.7
0.1
18.5 |
Total |
100.0 |
Table 3: Percentage distribution of all cases by type of medical personnel
consulted for antenatal care
Personnel consulted |
Percentage |
Doctor
Clinical Officer
Trained Nurse/Midwife
TBA
None |
2.6
13.4
65.4
0.1
18.5 |
Total |
100.0 |
Table 4 : Percentage distribution of adolescents utilizing antenatal
clinics by selected background characteristics
Background
Characteristics |
Visited |
Not visited |
Total |
Residence
Urban
Rural |
79.8
84.7 |
20.2
15.3 |
100.0
100.0 |
Age
10-15 years
16-20 years |
66.7
82.0 |
33.3
18.0 |
100.0
100.0 |
Occupation
Barmaid
Business
Employed
Farmer
Housemaid
Housewife
Student
Other |
30.0
73.6
91.5
84.9
22.2
85.6
75.4
64.7 |
70.0
26.4
8.5
15.1
77.8
14.4
24.6
35.3 |
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0 |
Marital Status
Divorced
Married
Single
Widowed |
88.9
86.8
73.2
100.0 |
11.1
13.2
26.8
100.0 |
100.0
100.0
100.0
100.0 |
Education
None
Primary (1-8) years
Secondary and above |
56.2
77.5
90.4 |
43.8
22.5
9.9 |
100.0
100.0
100.0 |
There are variations between urban and rural residents with more rural residents
consulting antenatal services compared with their urban counterparts. Young
adolescents have a low rate of utilization (i.e. 66.7 per cent) compared with
older adolescents who have 82 per cent rate of use. This is probably due to
fear of revelation of pregnancy, lack of information and other psychological
problems. As for the influence of occupation, it is observed that housemaids
and barmaids have the lowest rate of utilization whereas the highest rate
of use is amongst women in formal employment. There is also a marked difference
in utilization according to maternal level of education. Those with lower
education have lower utilization rates (i.e. 56.2 per cent for those with
none and 77.5 per cent for those with primary education level) compared with
those with secondary education (i.e. 90.4 per cent). This shows that education
plays an important role in improving utilization of antenatal services.
Birth Order and Previous Birth History
Information on parity, birth spacing and previous obstetric history is important
in determining the risk factors associated with childbearing. Research has
shown that close birth spacing leads to high risk of maternal and infant mortality
(WHO, 1993). Research has also shown that primigravidae who are normally under
20 years of age have higher incidence of difficult labour and thus a higher
number of assisted deliveries and caesarian sections (Dhutla, 1981).
Unfortunately the medical records examined in this study did not have detailed
data on past obstetric history of the respondents. They, however, had some
information on parity that is presented in Table 5.
Table 5 : Percentage distribution of all cases by number of previous
births
Previous births |
Percentage |
None
1
2
3
4 |
78.1
15.7
5.2
0.9
0.1 |
The table shows that most births (i.e. 78.1per cent) were primigravidae and
hence had higher chances of being risky due to low maternal age.
Reproductive Health Problems
From the cases reviewed, the major reproductive health problems reported
are, hypertensive disease of pregnancy, haemorrhage, obstructed labour, operational
deliveries and low birth weights. Also, cases of anaemia, neonatal deaths
and sexually transmitted diseases were reported. Table 6 shows the distribution
of major reproductive health problems recorded among the respondents.
Table 6 : Percentage distribution of major reproductive health
problems identified among the study cases
Problem |
Percentage |
With |
Without |
Total |
High blood-pressure
Haemorrhage
Obstructed Labour
Low Birth Weight
Episiotomy
Neonatal Death
Still Birth
STD
Anaemia |
31.5
29.2
28.6
27.2
11.8
7.4
6.8
4.6
4.1 |
68.5
70.8
71.4
72.8
88.2
92.6
94.2
95.4
95.2 |
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0 |
Hypertensive Disease of Pregnancy
The major disorders in most cases are high blood pressure, protein in the
urine and swelling of tissues. Past research shows that if this condition
is left untreated it becomes severe and the patient may die within two days
(Maine et al., 1991). For the purpose of this study, data on blood pressure
is relied on to measure the severity of hypertensive disorders among adolescent
mothers. The results from Table 6 show that 35 per cent of adolescent mothers
suffer from high blood pressure before delivery. The causes of hypertensive
disorders have not been properly documented. However, research done elsewhere
shows that ones way of life greatly plays a role in determining blood pressure
(WHO, 1994). The percentage distribution of all cases by their blood pressure
according to selected background characteristics is shown in Table 7.
From the table the proportion of women with high blood pressure is high (36.2
per cent) for rural residents compared with urban residents (29.0 per cent),
it is also high for those aged 10-15 years (46.7 per cent) compared with those
aged 16-20 years (31 per cent). When one considers maternal occupation, the
proportion of the respondents with high blood pressure is highest for farmers
followed by students, housewives and business women in that order. This probably
indicates the level of stress due to nature of work and other psychological
problems. On the side of marital status, single mothers have higher chances
of having high blood pressure compared with married or ever married mothers:
ever married here combines both divorced and widowed. Mothers with high level
of education have less incidence of high blood pressure as against those with
no education.
Haemorrhage
Bleeding related to late pregnancy and delivery can be divided into two categories
namely, antepartum haemorrhage in which vaginal bleeding occurs before birth
and postpartum haemorrhage where excessive bleeding occurs shortly after birth
of the baby. In this study, postpartum haemorrhage was the major reproductive
health problem reported and 29.2 per cent of the respondents reviewed experienced
it. The major causes of postpartum haemorrhage that have been identified in
the past are retained placenta, prolonged labour, operative vaginal delivery,
the action of anaesthetic agents and uterine tumour such as fibroid (Royston
and Armstong, 1989). The risk of dying from postpartum haemorrhage depends
on the amount and rate of blood loss, and on the state of health of the patient.
It is, however, estimated that a woman with haemorrhage cannot live for two
hours unless she receives treatment (Royston and Armstong, 1989). Table 8
shows percentage distribution of all the examined cases, whether they experienced
postpartum haemorrhage by selected background characteristics.
Table 7 : Percentage distribution of all cases by their blood pressure
according to selected background characteristics
Characteristics |
High |
Normal |
Low |
Residence
Rural
Urban |
36.2
29.0 |
53.2
55.3 |
10.6
14.4 |
Age
10-15 years
16-20 years |
46.7
31.1 |
26.7
55.4 |
24.4
12.7 |
Occupation
Barmaid
Business
Employed
Farmer
Housemaid
Housewife
Student
Other |
10.0
27.3
24.5
59.7
22.2
28.1
48.5
24.1 |
50.0
52.1
61.3
39.5
59.3
58.0
39.5
56.9 |
40.0
19.8
13.2
0.8
22.2
12.9
12.0
16.4 |
Marital Status
Divorced
Married
Single
Widowed |
11.1
27.9
37.7
0.0 |
80.0
58.3
48.1
66.7 |
8.9
13.0
13.0
3.3 |
Education Level
None
Primary
Secondary Plus |
42.3
36.2
27.4 |
41.2
48.7
60.7 |
15.1
14.2
11.2 |
From Table 8, it is observed that there is a marked difference between rural
residents (38.3 per cent) compared with their urban counterparts who experienced
slightly low rates of postpartum haemorrhage (25.9 per cent). This is also
evident when one considers age whereby a higher percentage (45.2 per cent)
of mothers aged 10-15 years experienced postpartum haemorrhage compared to
only 29.4 per cent of mothers aged 16-20 years. The same trend appears when
one considers marital status where a great proportion of single mothers experienced
postpartum haemorrhage compared to ever married. Level of education also seems
to play a role in determining haemorrhage as it is a small proportion of women
with secondary level of schooling and above who experience postpartum haemorrhage
compared with those with no education and primary level schooling.
Table 8 : Percentage distribution of all cases with post-partum haemorrhage
by selected background charactersitics
Characteristics |
Total |
Residence
Urban
Rural |
38.3
25.9 |
Age
10-15 years
16-20 years |
45.2
29.4 |
Occupation
Barmaid
Business
Employed
Farmer
Housemaid
Housewife
Student
Other |
20.0
30.6
21.6
55.4
22.8
27.0
45.0
29.3 |
Marital Status
Divorced
Married
Single
Widowed |
26.2
25.3
37.5
10.5 |
Education
None
Primary
Secondary Plus |
37.9
38.0
21.1 |
Obstructed Labour
In most cases, obstructed labour in adolescence arises because the space
in the bony birth canal of the mother is either too small or too distorted
by disease to permit easy passage of the head of the baby during labour. Several
reasons have been advanced to determine the stature of a person and how it
affects labour. Some of them are genetic, physiological, environmental and
nutritional factors (Royston and Armstong, 1989). In this study, data on the
frequency of operative deliveries is used to indicate occurrence of obstructed
labour. The most frequent operative deliveries that were reported were vacuum
extraction which accounted for 10.4 per cent of total deliveries, and caesarian
section which was commonest accounting for about 18.2 per cent of total deliveries.
The remaining 71.4 per cent were normal deliveries. Operative deliveries are
associated with risks to the mother and the infant which arises partly from
the nature of operation and the complications which necessitated the operation
in the first place. There are other complications such as infections and severe
bleeding that may follow a delivery. Table 9 shows the percentage distribution
of all women by nature of delivery across background characteristics.
Table 9 : Percentage distribution of all cases by nature of
delivery according to selected background characteristics
Characteristics |
Cesarian |
Normal |
Vacuum |
Total |
Residence
Rural
Urban |
20.1
10.6 |
65.7
85.9 |
14.2
4.5 |
100.0
100.0 |
Age
10-15 years
16-20 years |
8.9
9.0 |
60.0
86.3 |
31.1
4.7 |
100.0
100.0 |
Occupation
Barmaid
Business
Employed
Farmer
Housemaid
Housewife
Student
Other |
10.0
7.4
7.5
11.8
5.5
10.3
13.2
1.7 |
80.0
80.1
90.6
74.9
76.0
86.8
64.7
92.2 |
10.0
12.5
1.9
13.4
18.5
2.9
22.2
6.0 |
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0 |
Marital Status
Divorced
Married
Single
Widowed |
23.3
8.9
13.2
7.5 |
66.7
88.6
64.7
80.6 |
10.0
2.0
22.2
11.9 |
100.0
100.0
100.0
100.0 |
Education Level
None
Primary
Secondary Plus |
19.6
10.4
6.9 |
72.2
73.4
88.8 |
8.2
16.2
4.3 |
100.0
100.0
100.0 |
From data in Table 9, it is observed that operative deliveries due to obstructed
labour are higher for rural residents; mothers aged between 10-15 years; single
mothers and mothers who have low level of education. This supports earlier
findings that most extreme forms of pelvic contraction are found in societies
where there is mass poverty and where childbearing begins early before girls
are fully developed (WHO, 1993).
Birth Weight
The World Health Organization defines low birth weight as a birth weight
less than 2500 grammes, because below this value, risks of infant mortality
are extremely high. Babies weighing less than 2500 grammes are much more susceptible
to illness and infection than heavier babies. In other words, if they are
far below that weight, they are likely to die (WHO, 1993).
Out of all the cases reviewed in this survey, 30 per cent of births were
low birth weight. Though the cause of low birth weight remains unexplained,
there
are some risk factors that have been identified. These include; gender, ethnic
origin, socio-economic status, maternal height, parity, STDs, malaria, smoking,
alcohol consumption, etc. (Walsh et al., 1993).
Table 10 : Percentage distribution of all study cases by birth weight
according to selected background characteristics
Characteristics |
Birth weight |
Total |
<2500g |
>2500g |
Residence
Rural
Urban |
36.4
22.2 |
63.6
77.8 |
100.0
100.0 |
Age
10-15 years
16-20 years |
66.7
33.3 |
26.3
72.7 |
100.0
100.0 |
Occupation
Barmaid
Business
Employed
Farmer
Housemaid
Housewife
Student
Other |
80.0
17.4
17.0
31.9
55.6
18.3
16.5
30.5 |
20.0
82.6
83.0
68.1
44.4
81.7
33.5
69.5 |
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0 |
Marital Status
Divorced
Married
Single
Widowed |
44.4
16.8
53.3
33.3 |
55.6
83.2
46.7
66.7 |
100.0
100.0
100.0
100.0 |
Education Level
None
Primary
Secondary Plus |
35.6
33.5
17.4 |
64.4
66.5
82.6 |
100.0
100.0
100.0 |
Table 10 presents data on birth weights from all the study cases according
to selected background characteristics. The data shows that a higher proportion
of rural mothers deliver low birth weights than urban residents. This trend
is also true for young adolescents aged 10-15 years, single mothers, and those
with low level of education. Thus, it confirms the assumption that low level
of socio-economic status and age are key risk factors to low birth weights.
Anaemia
Anaemia describes the condition in which there is a reduction of the concentration
of haemoglobin in the blood stream (of a pregnant woman). It is mainly caused
by nutritional deficiency of iron and folic acid. Other causes include sickness
from malaria, sickle cell, bacterial infection, blood loss and intestinal
parasites. Only 4.7 per cent of all the respondents were recorded to have
had anaemia.
Sexually Transmitted Diseases (STDs)
Sexually transmitted diseases (STDs) form another major potential consequence
of unprotected sexual activity during adolescence. In most cases, STDs tend
to have adverse effects on future fertility. Screening of all pregnant women
has long been advocated both because of specific risks of consequences of
infection in pregnancy to the woman and fetus and as an opportunistic screening
of sexually active population in an attempt to control the spread of diseases.
Even though the particulars of the diseases were not included, the data collected
showed that 4.1 per cent of the respondents had been infected with STDs.
Perinatal Health Problem
Perinatal health reflects the health of women and the quality of care during
pregnancy, delivery and the neonatal period. Perinatal deaths include stillbirths
(also called fetal deaths) and deaths in the first week of life. Other than
low birth weights discussed earlier, perinatal health can be measured by the
number of reported stillbirths and neonatal deaths. Data on stillbirths and
neonatal deaths was sketchy but then it indicates that 7.4 per cent of recorded
births ended up dying immediately whereas 6.8 per cent of births were stillbirths.
Even though the data was not detailed enough for us to ascertain the causes
of the neonatal death and stillbirths that were reported, other studies have
identified some of the causes of these problems. These include; infection
of amniotic fluid, congenital syphilis, compression of the umbilical cord,
birth trauma, obstructed labour, premature rupture of the membranes and congenital
malformations (Walsh et al., 1993).
CONCLUSIONS AND POLICY IMPLICATIONS
This paper has outlined the major reproductive health problems facing adolescents
in Kenya. Most important among them are high blood pressure, haemorrhage,
obstructed labour, low birth weight, sexually transmitted diseases, anaemia,
maternal and perinatal mortality.
The severity of these problems has been found to vary with the socio-economic
and demographic characteristics of the mother. The reproductive health problems
have been found to be higher for mothers who have low levels of education,
do not utilize antenatal services, are aged below 15 years old, are residents
of rural areas, and are single, and not in formal employment. The same study
reveals that most adolescents have never used any modern contraceptive method,
while a good number of them are single, not gainfully employed and have only
attained primary level of education. Any policy measure should therefore address
the above issues.
The current policy of the government of Kenya on safe motherhood involves
two activities, i.e. establishing a full range of maternal child health as
well as family planning services, and training of traditional birth attendants
to assist mothers deliver safely and hygienically. These, however, are contradicted
by the governments declaration that contraceptives should not be made available
to unmarried youths and other forms of family life education programmes must
not be imparted in Kenyas schools (Njau, 1993). The scenario that arises
is that efforts to deal with unwanted pregnancies amongst the youth are paralysed.
The present studys findings, therefore, lead to the following policy recommendations:
- the government should consider introducing family life education
early, preferably, in primary schools, with a view to making the adolescents
understand more about their bodies; this would encourage use of contraceptives;
(b) because family planning services in Kenya are more couple-oriented and
unavailable to single adolescents, the government should demystify contraceptive
use and promote the use of safe sex methods for adolescents;
(c) the government and other NGOs should encourage the use of prenatal services
and provide them free to all mothers irrespective of social class. Emphasis
should be on the quality of care by ensuring that there are enough trained
human resources, basic facilities and drugs for safe delivery;
(d) introduction of socio-economic reforms aimed at reducing poverty amongst
the population through gainful employment for females and gender equality.
Improvement of transportation facilities in the rural areas will help to improve
accessibility to the existing medical facilities;
(e) there should be policies targeting the poor pregnant adolescents and
single mothers. The policies should be expanded to include incentives to adolescents
who are pregnant and those with children to continue their education, rather
than dropping out of school. These may include easy access to childrens day-care
services and scholarships;
(f) vocational training should be encouraged to increase the productivity
and earnings of poor women employment opportunities in the modern sector of
the economy; policy makers could target poor women as direct beneficiaries
of government development policies for small scale industries, especially
agro-industries. On the social level, policies are required to increase the
cost of fathers abandonment of their children through laws that mandate the
economic contribution of biological fathers to child maintenance.
The problem of adolescent reproductive health, therefore requires an
integrated approach whereby socio-economic reforms complement the health sector
with policies directed towards the poor and disadvantaged mothers, who are
also malnourished and at high risk of contracting diseases many of which are
fatal.
REFERENCES
- Aggarwal, V.P. and J.K.G. Mati. 1992. Epidemiology of Induced Abortion
in Nairobi, Kenya. Journal of Obstetrics and Gynaecology of Eastern and
Central Africa. 54(3).
- Ajayi, A.O. et al. 1991. Adolescent Sexuality and Fertility in Kenya ;
A Survey of Knowledge Perceptions and Practices. Studies in Family Planning 22
(4) 203-216.
- AMREF, 1994. Female Adolescent Health and Sexuality in Kenya Secondary
Schools ; A Survey Report.
- Barker, G.K. and S. Rich. 1992. Influences of Adolescent Sexuality in Nigeria
and Kenya ; Findings of Recent Focus Group Discussions, Studies
in Family Planning Vol.23 No.3.
- Barreto, T. et al. 1992. Investigating Induced Abortion in Developing
Countries ; Methods and Problems, Studies in Family Planning Vol.23
No.3.
- Dhutia, H.P. (1981). Primigravida on Labour at the Coast. Medicom Vol.3.1.
- Feyisetan, B. and A.R. Pebley. 1989. Premarital Sexuality in Urban Nigeria, Studies
in Family Planning, 20(6) 343-354.
- Geronimus, A.T. 1987. Teenage Childbearing and Neonatal Mortality in United
States. Population and Development Review Vol.2.
- Ilinigumugabo, A. Njau, P.W. and Rogo K. (1994). The Social-Cultural and
Medical Outcomes of Adolescent Pregnancies. A Survey Report of Four
Rural Districts. Centre for African Family Studies, Nairobi, Kenya.
- Kenya, Republic of . 1993. Kenya Demographic and Health Survey,
NCPD; Nairobi.
- Kiragu, K. 1991. The Correlates of Sexual and Contraceptive Behaviour in
School Adolescents in Kenya, A Ph.D Thesis The Johns Hopkins University.
- Kulin, H.E. 1980. Adolescent Pregnancy in Africa : A Programmatic
Focus, Social Science and Medicine 26, (7) 727-735.
- Lema, V.M. et al. 1987. Review of Medical Aspects of Adolescent Fertility
in Kenya Journal of Obstetrics and Gynaecology for East and Central Africa.
- Liku, J. 1987. The Socio-Economic Factors Associated with Teenage Pregnancy
in Makueni Dunson M.A. Thesis, University of Nairobi.
- Maggwa, A.B.N. 1987. Knowledge, Attitude and Practice, a Survey of Contraceptive
Use and Teenage Pregnancy Living in a Rural Set-up of Kenya. M.Med Thesis
University of Nairobi.
- Maine, D. 1991. Safe Motherhood Programs and Options. Division
of Family Health, Columbia University.
- Makinson, C. 1985. The Health Consequences of Teenage, Family Planning
Perspectives Vol.17, No.3.
- Mati, J.K.G. 1989. Review on Adolescent Health, Journal of Obstetrics
and Gynaecology of East and Central Africa Vol.8, No.1.
- Njau, P.W. (1993). Factors Associated with Pre-Marital Teenage Pregnancies
and Childbearing in Kiambu and Narok Districts. Ph.D. Thesis, University
of Nairobi.
- Royston, E. and S. Armstong, 1989. Preventing Maternal Deaths.
World Health Organization.
- Shangvi, H.C. et al. 1983 Nairobi Birth Survey : Outcome of
Pregnancy in Teenage Mothers in Nairobi, Kenya. Journal of Obstetrics
and Gynaecology for Eastern and Central Africa 69(3).
- Senderowitz, J. and J.M. Paxman. 1985. Adolescent Fertility : Worldwide
Concerns. Population Bulletin Vol.40, No.2. : Evidence from
Developing Countries. Vol.II, New York ; Population Studies, No.109.
- Walsh, J. et al. 1993. Maternal and Perinatal Health in Disease
Control Priorities in Developing Nations edited by Jamison D.T. et
al World Bank.
- World Health Organization. 1993. Health for Young People : A Challenge
and Promise.
- WHO. 1994. Mother, Baby Package ; Implementing Safe Motherhood in
Countries.
Copyright 1997 - Union for African Population
Studies.
|