Gender inequality, difficulties in accessing services and poverty are fuelling high rates of unintended pregnancies and HIV in Homa Bay, Western Kenya – according to a new report commissioned by Homa Bay County Government and carried out by ODI and LVCT Health, with support from UNICEF.

The report, ‘Unintended Pregnancies and HIV Amongst Adolescents and Young People: A Situation Analysis of Homa Bay, Kenya’, highlights that one third (33 per cent) of adolescent girls aged 15 to 19 in Homa Bay are mothers or pregnant with their first child, almost twice the national average of 18 per cent. More than one in 20 young people aged between 15 and 24 in the county are HIV positive (6.2 per cent), more than three times the national average. There are similar trends in other Western Kenyan counties.

“We must take urgent steps to make sure children and young people receive the information and support they need to protect themselves from unintended pregnancy and HIV,” said Maniza Zaman, UNICEF Representative to Kenya. “This is particularly relevant during the COVID-19 pandemic, when safety nets like school have been fully or partially closed and we fear rates of teenage pregnancy and HIV could rise further.”

Adolescent girls were identified as particularly vulnerable, as they often have little say in relationships and the use of condoms, face pressure from peers or wider society to get pregnant or marry early, or circumstances force them into transactional sex – for example to buy fish to feed their families. Many girls told researchers they lacked access to, or awareness of, relevant HIV, sexual and reproductive health services.

“We need a society-wide shift for men, women, girls and boys to all understand the risks young people face and to challenge harmful gender norms,” said Professor Richard Muga, Head of Health Services in Homa Bay County, who commissioned the report. “The County Government is committed to taking urgent action in response to the report’s findings in order to reduce unintended pregnancies and lower rates of HIV.”

The report is based on a review of the available literature plus interviews with 112 adolescents, parents, government officials and service providers in Homa Bay Town and Ndhiwa Constituency. It also highlights other key drivers of adolescent HIV and pregnancy, including:

• poor sex and reproductive health education in schools, which is not equipping adolescents with the skills and knowledge they need to stay safe
• lack of centralised adolescent health programmes funded by the Government
• cultural practices such as disco matanga (disco funerals), a practice of the Luo in Nyanza province, where people sleep under the same roof for several days
• risky behaviours such as having multiple partners, unprotected sex and taking drugs.

“It is critical we understand the underlying drivers of high teenage pregnancies and HIV, including stigma, social norms around expected behaviours and peer pressure to engage in sexual relations at an early age and to get pregnant,” Dr Fiona Samuels, Senior Research Fellow at ODI and Principal Investigator for the study, said. “Without this understanding programmes and policies will continue to fail adolescents, and especially girls.”

HIV and pregnancy can have huge health, psychological and socio-economic impacts on young people. The leading cause of death among girls aged 15 to 19 worldwide is pregnancy and childbirth complications. Girls who are pregnant or have HIV can end up dropping out of school and experiencing depression or poor health. Adolescent girls who get pregnant are also more at risk of child marriage and can face life threatening complications during childbirth, as their bodies are not yet ready to give birth. They often become economically dependent on their partner and more at risk of violence and abuse. It can be a vicious cycle.

UNICEF, together with the UN family, works with the Government of Kenya at national and county level to ensure adolescents are protected from violence and harmful cultural practices and that they have access to HIV prevention and care services, as well as appropriate sexual reproductive health services. UNICEF is advocating for the Government and partners to urgently implement the report’s key recommendations, which include:

• Improved and budgeted programming – focusing on addressing harmful gender norms, as well as better dissemination in schools of information on sexual reproductive health, HIV and services to tackle violence
• Increased financial support and training opportunities – including grants for the most vulnerable girls during school years and tailored training, education and skills development to give girls alternatives to marriage and early pregnancy
• Improved sexual and reproductive health and HIV services – including training for staff, providing easy access to free family-planning supplies in private spaces, and increasing the availability of counselling.

“We commend the Government of Homa Bay for commissioning this crucial report that can help bring about change for the entire Western Kenya region,” UNICEF’s Maniza Zaman said. “We look forward to working together to improve services for young people and to equip them with the skills and knowledge they need to stay safe and healthy, giving them the best chance in life.”