REPRODUCTIVE
HEALTH
DEVELOPMENT
POLICY
National Council
for Population and
Development (NCPD) Division of
MINISTRY OF PLANNING Reproductive Health
& NATIONAL DEVELOPMENT MINISTRY OF HEALTH
April 2003
The development and printing of this
Adolescent
Reproductive Health and Development Policy document was
supported by the United Nations Population Fund (UNFPA)
under the 5th Country Programme of Assistance to
Contents
Abbreviations.................................................................................
Acknowledgements ......................................................................
Foreword........................................................................................
Preamble ........................................................................................
1. NATIONAL COMMITMENT ......................... … ..................
2. PRINCIPLES ...............................................................................
3. CURRENT SITUATION ...........................................................
3.1 Population Size and Growth ....................... ....................
3.2 Age Structure ....................................................................
3.3 Children ...............................................................................
3.4 Adolescents and Youth ...................................................
3.5 Poverty and Socio-Economic Issues ..............................
3.5.1 Children in the labour market..................................
3.5.2 School enrolment and dropout ..............................
3.5.3 The family ..................................................................
3.5.4 Migration ...................................................................
3.6 Reproductive Health Information and Services ...........
3.6.1 HIV/AIDS and STIs ................................................
3.6.2 Safe motherhood .....................................................
3.6.3 Reproductive rights.................................................
3.6.4 Unsafe abortion .......................................................
3.7 Harmful Practices ..............................................................
3.7.1 Early marriage ...........................................................
3.7.2 Female genital cutting..............................................
3.7.3 Sexual Abuse and Violence....................................
3.7.4 Drug and substance abuse.....................................
3.8 Gender Perspectives..........................................................
4. STRATEGIC
ACTIONS FOR ADOLESCENT AND YOUTH HEALTH
4.1 Adolescent Sexual and
Reproductive Rights and Health
4.2 Harmful Practices...............................................................
4.3 Drug and Substance Abuse.............................................
4.4 Socio-Economic Factors...................................................
4.5 Young People with
Disabilities........................................
5. GOAL,
OBJECTIVES AND TARGETS.................................
5.1 Objectives...........................................................................
5.2 Targets.................................................................................
5.2.1 Health Targets..........................................................
5.2.2 Demographic Targets..............................................
5.2.3 Social Services Targets...........................................
6. IMPLEMENTATION
STRATEGIES.....................................
6.1 Advocacy............................................................................
6.2 Behavior Change Communication
(BCC).......................
6.3 Provision of
Adolescent-Friendly Reproductive Health Services
6.4 Research..............................................................................
6.5
6.6 Resource Mobilization......................................................
6.7 Networking and Community
Participation.....................
6.8 Monitoring and Evaluation..............................................
7. INSTITUTIONAL
FRAMEWORK........................................
7.1 Implementation
Responsibilities......................................
7.2 Roles of Government
Ministries and Agencies............
7.3 Roles of Non-Government
Entities..................................
8. Conclusion................................................................................
Glossary...........................................................................................
Abbreviations
AIDS Acquired
immune deficiency syndrome
ANC Antenatal
care
ARH&D Adolescent
reproductive health and development
ASFR Age
specific fertility rate
ASRH Adolescent
sexual and reproductive health
BCC Behaviour
change communication
CSA Centre
for the Study of Adolescence
DDA Dangerous
drug addicts
DDC District
Development Committees
DP&FPC District Population and Family Planning
Committees
EFA Education For All
FGC Female
genital cutting
GER Gross
enrolment rate
HIV Human
immunodeficiency virus
IEC Information,
education and communication
IMR Infant
mortality rate
KAPAH
KDHS
MDGs Millennium
Development Goals
MMR Maternal
mortality rate
MOH Ministry
of Health
NACC National
AIDS Control Council
NCPD National
Council for Population and Development
NGO Non-government
organization
NPPSD National
Population Policy for Sustainable Development
RTI Reproductive
tract infections
STD/STI Sexually
transmitted disease/infection
TFR Total fertility
rate
UNFPA United Nations
Population Fund
UPE Universal primary
education
VCT Voluntary
counselling and testing
WHO World
Health Organization
YMCA Young
Men's Christian Association
YWCA Young
Women's Christian Association
Acknowledgements
Many people and organizations were Involved in
the lengthy participatory process that culminated in this Adolescent
Reproductive Health and Development Policy, an initiative of the 6th Council of
the National Council for Population and Development (NCPD) under the
Chairmanship of Dr. Khama Rogo. The initial data collection was done by young
people from the Kenya Association fir the Promotion of Adolescent Health
(KAPAH), with valuable technical and financial assistance from the Centre for
the Study of Adolescence (CSA) and Pathfinder International.
The Policy benefited immensely from inputs and
comments from a series of meetings and stakeholder workshops that reviewed the
document in various stages over 2001-2002. Valuable comments were received from
the Ministry of Health, while the NCPD Secretariat under the guidance of
Its director, Amb. S.B.A. Bullut, and Mr.
Karugu Ngatia the Senior Assistant Director did a commendable job. The
Government is very grateful to all of them for their participation and
contributions.
Special thanks go to all members
of the Reproductive Health Committee chaired by Prof. S.K. Sinel and to the
Task Force put in place to review and
improve this Policy.
The
work would not have been possible without the contribution and financial
support of the Kenya Country Office of the United Nations Population Fund (UNFPA)
and technical assistance from the Country Support Team (CST) -
Finally, the Government would like to thank all other
individuals and institutions who contributed In one way or the other to this
effort to improve the quality of life of
Hon. Prof.
Anyang'Nyong'o, MP MINISTERFORPLANNING
AND NATIONAL DEVELOPMENT
Aprii2003
Foreword
Over a quarter of
The Policy is grounded in the understanding that the relationship between
a nation's development and the health of its adolescents and youth Is of
paramount concern - particularly when those age groups form such a dominant
portion of the population. While generally regarded as brimming with health,
adolescents face many reproductive health problems that
negatively affect their general health and development -
early pregnancy, school dropout and sexually transmitted infections including
HIV/ AIDS. Furthermore, more than 50 per cent of
As it outlines measures designed to address
the concerns about adolescents and the youth raised in various international
conventions, conferences and other instruments, such as the Millennium
Development Goals, the Policy is also responsive to Sessional Paper No. 1 of
2000 on the National Population Policy for Sustainable Development (NPPSD), the
National Reproductive Health Strategy 1997-2010 and the Children's Act of
2001, among others. A clear manifestation of the Government's commitment to
fulfill its obligations in the area of adolescent reproductive health, the
development and adoption of this Policy is a positive attempt to address these
issues as a national development concern.
The Policy takes into consideration the
vulnerable state adolescents and young people find themselves in and the
expected roles of government, communities and other stakeholders In redressing
that vulnerability. To facilitate the successful Implementation of the Policy
a concrete work plan will be developed in order to increase commitment,
partnership, collaboration and networking among all stakeholders. The plan will
link information to behaviour change and delivery of RH services.
We expect that all stakeholders, particularly
service providers both private and public, will find this Policy document and
its plan of action useful. Any support or feedback will be greatly appreciated.
Hon. Charity
KaiukiNgilu, MP
MINISTER FOR HEALTH
Preamble
This Adolescent Reproductive Health and Development Policy (ARH&D)
responds to concerns about adolescents raised in the National Population Policy
for Sustainable Development (NPPSD), the National Reproductive Health Strategy,
the Children's Act (2001), and other national and International declarations
and conventions on the health and development of adolescents and youth.
The Policy Intends to bring adolescent health
issues into the mainstream of health and development. The Policy examines the
prevailing social, economic, cultural and demographic context of adolescent
sexual and reproductive health, Its implications and consequences to their
health and development. As a complement to sector-specific policies and
programmes, the Policy defines the structures and key target areas for ensuring
that adolescent health concerns are mainstreamed in all planning activities.
The goal of the Policy Is to contribute to the improvement of the
quality of life and well being of
Among the key objectives of this Policy are
the identification and definition of adolescent health and development needs;
provision of guidelines and strategies to address adolescent health concerns;
and promotion of partnerships among adolescents, parents and communities. The
Policy also seeks to create an enabling legal and social-cultural environment
that facilitates the provision of information and services for adolescents and
youth. It will promote and protect adolescent reproductive rights; strengthen
inter-sector coordination and networking in the field of adolescent health and
development; and enhance participation of adolescents in reproductive health
and development programmes. Finally, the Policy Identifies and defines monitoring
and evaluation indicators for adolescent reproductive health and development.
The Policy outlines a set of strategies that
will be pursued to meet the goal, objectives and targets. The Policy will be
implemented through a multi-sector, Interdisciplinary and multidimensional
approach. The roles of the various stakeholders are outlined and will be
coordinated In order to optimize the use of resources. This Policy reinforces
the commitment of the Government to the integration of young people into the
national development process.
The, Policy recognizes the critical roles adolescents themselves can play in promoting their own health and development:
National
Commitment
In pursuance of the goal of giving priority to the health and
development of adolescent members of the population of Kenya within the context
of the nation's overall development, so that adolescents in Kenya achieve and
maintain total health and well-being as defined by the World Health
Organization;
Guided by the
principles derived from the National Reproductive Health Strategy; the National
Population Policy for Sustainable Development; the Children's Act 2001; the
International Conference on Population and Development; the Universal
Declaration of Human Rights; the Convention on the Elimination of All Forms of
Discrimination Against Women; the
International Convention on the Rights of the Child; the Fourth World
Conference on Women; the International Conference on Social Development; the
United Nations World Programme for the Youth for the Year 2000 and Beyond, and
other relevant statements of commitment to the health of young people;
Acknowledging the
interest of both local and international agencies in the promotion of the
health and development of young persons in furtherance of the commitments
indicated above, and appreciating that the various programmes and projects currently being implemented or
planned require support and coordination, in accordance with the priorities,
principles and strategies indicated in this Policy;
Conferring upon the Ministry of Health and the Ministry
of Planning and National Development, through the National Council for
Population and Development, the mandate to mobilize the necessary resources
from the health and other sectors to effect the reorientation of existing and
planned services, at all levels, to address the reproductive health and related
needs of adolescents;
Recognizing the need for a specific policy framework to
facilitate effective response, in terms of rearranging the nation's resources
and priorities to better address the reproductive health service, information
and other needs of adolescents and youth, and knowing that such a policy
framework as hereby articulated was hitherto nonexistent;
Convinced that
optimal health of the adolescent population of Kenya will increase their
productive capacity to contribute to the nation's development;
Appreciating the devastating effect of the HIV/AIDS
pandemic and its potential long-term impact on the nation owing to an
increasing rate of infection among adolescents, and the need for a
comprehensive policy response to this pandemic as a matter of urgency; and
Aware of the important role and potential of adolescents and youth themselves
in making decisions and choices that will go a long way towards mitigating the
problems of poor reproductive health and irresponsible sexual activities;
The Government of Kenya hereby proposes this document as the Kenya
Adolescent Reproductive Health and Development (ARH&D) Policy, hereinafter
referred to as The Policy.
Principles
This Adolescent Reproductive Health and Development Policy flows from
the following basic principles:
i) The Policy is grounded in fundamental human rights and freedoms. The Policy therefore respects human rights and freedoms relating to social, economic, cultural and religious beliefs and practices.
ii) The Policy recognizes
the critical roles adolescents themselves can play in promoting their own
health and development and emphasizes the need for their participation in
decision making, planning, implementation, monitoring and evaluation of
programmes addressing their own needs.
iii) The Policy recognizes
that gender considerations are fundamental to adolescent and youth health
because they are important determinants of access to economic resources, social
services, education and other opportunities.
iv) The Policy recognizes
that not all young people are equally vulnerable. Young people who are
homeless, abused, abandoned, orphaned, refugees and single parents have very
different and challenging life situations.
v) The Policy reaffirms the
role of parents, communities, education institutions and religious
organizations in assisting young people to develop positive norms, attitudes
and values.
Current Situation
Kenya is a young nation with a wide range of
challenges that are typical of a developing country, including a youthful
population that is growing in the face of relatively slow economic growth.
These and other facets of Kenya's current position are detailed in the
following sections.
3.1 Population Size and Growth
Kenya's
population increased from 5.4 million in 1948 to 16.2 million in 1979, and
thence to 23.2 million in 1989 and 28.7 million in 1999. It is projected to
reach 36.5 million by 2010 and 39.7 million by 2015. The annual growth rate declined
from 3.8 per cent in 1979 to 2.6 percent in 1999. According to the 1999
population census, those aged 10-24 years number 10.3 million (5.1 million
males and 5.2 million females).
3.2 Age Structure
The age-sex structure of Kenya's population is heavily skewed towards
children and young people. The Kenyan population pyramid is wide-based, with those below 25 years constituting 18.8
million, which represents about 66 per cent of the total population, a pattern
that is typical of populations with high fertility rates and strong population
momentum: The 1998 Kenya Demographic and Health Survey (KDHS) shows that the
population under 15 years of age fell from 53 per cent in 1989 to 49 per cent
in 1993 and to 46 per cent in 1998. As a result of this shift, the dependency
ratio in Kenya dropped from 127 in 1989 to 112 in 1994 and to 98 in 1998.
3.3 Children
Children, defined as persons below 18 years,
constituted 52.7 per cent of Kenya's total population in 1999. This young
population exerts pressure on the demand for services such as education,
health, food and shelter. Socio-economic changes and poverty have led to an
increase in the number of children living under difficult circumstances such as
street children and families, abandoned and neglected children, abused and
exploited children, teenage mothers, and refugee children.
3.4 Adolescents and Youth
Whereas adolescents are defined as persons
aged 10-19, the World Health Organization (WHO) defines the youth as persons
aged 10-24 years. According to the 1999 Population and Housing Census, youth so
defined constitute about 36 per cent and the adolescents 25.9 per cent of
Kenya's population. This proportion has major demographic, social and economic
implications, including strain on the national economy, pressure on the
provision of social services and demand for employment, as well as high
dependency. Yet adolescents and youth are the nation's future, an important
resource whose capacities need to be tapped for development. These are ages of
promise and opportunity, challenges and risks. The risk is related to the
development of a sense of identity, including adoption of value systems.
Because many of the decisions people make in adolescence and youth influence
them for the rest of their lives, it is imperative that people in these age
groups be supported to make responsible life choices.
3.5 Poverty and Socio-Economic Issues
An estimated 52 per cent of the Kenyan population lives below the
poverty line. Poverty is multifaceted and manifests itself through inadequacy
of income, deprivation of basic needs and rights, lack of access to productive
assets as well as to social infrastructure. Youth are adversely affected by the
increasing incidence of poverty, which limits their access to essential social
services such as basic education, health, water and sanitation. Females are
disproportionately affected.
Young
people constitute a major potential resource for Kenya's economic development.
Yet the poor performance of the economy, coupled with the impact of structural
adjustment programmes, (SAPs) have adversely affected their absorption in both
public and private sectors.
Consequently, the majority of the young people wishing to enter the
labour force have not been able to secure employment to support themselves. Idleness
among the youth leads to crime, drug and substance abuse, and involvement in
other anti-social behaviour, while poverty aggravates the rate of HIV
infection.
3.5.1 Children in the Labour Market
According to the 1999 Population and Housing Census, 3.4 million out of 10.0
million children aged 5-17 years were reported to have worked during the
seven days preceding the census. The proportion of working children was higher
(about 45 per cent) among the older ones (14-17 years) than those aged 5-9
years, who formed 26 per cent of
the working children. The proportion of boys was higher. For all working
children, 95 per cent resided in the rural areas.
Involvement of children in the labour market denies them access to education,
exposes them to exploitation, and limits their access to RH information and
services as well as opportunities for self-advancement.
3.5.2 School Enrolment and Dropout
The 1999 Population and Housing Census indicates that 85 per cent of persons aged 6-15 are in school, with enrolment levels being
almost equal in both rural and urban areas. However, with the introduction of
universal primary education (UPE) in January 2003, enrolment increased
substantially. For the age group 15-19, more boys are enrolled than girls. In
rural areas more girls (55 per cent ) are enrolled in school as compared with
urban areas (30 per cent ).
There has been a general declining pattern in
school enrolment across all age groups, except age 6-9 years where improvements
have been recorded in the last two decades. Enrolment in this age group
increased remarkably from 50 per cent in 1979 to 76 percent in 1999. But
primary school enrolment, measured by the gross enrolment rate (GER), declined
from 106 per cent in 1989 to 101 percent in 1999. The proportion of the
population aged 10-14 years that had dropped out of school increased from 1 per
cent in 1979, through 5 per cent in 1989 to 8 percent in 1999.
By age 20, about 85 per cent of
the would-be-in-school population had dropped out of school. School retention rates
are therefore highest at primary level, lower at secondary level, and lowest at
tertiary and university level. Factors contributing to school dropout include
poor sanitation in schools, uninteresting learning environments, sexual
harassment, early and forced marriage, teenage pregnancy, poverty, and harmful
practices such as female genital cutting (FGC).
3.5.3 The Family
The family, the basic unit of society, is undergoing profound change, a
phenomenon that has far-reaching social and economic consequences that affect
development. The nuclear family, defined as consisting of a mother, father and
their children, is gaining dominance over the traditional extended family
system. Yet despite its diminishing influence as traditional cultural systems
give way to modernization, the extended family is still a source of care of
orphaned children and of guidance and counselling for adolescents, although to
a lesser extent than in the past.
Among other family structures emerging as a
result of social transitions and other factors are single parent families,
child-headed families and families headed by elderly people. One of the impacts
of the HIV/AIDS epidemic, for example, is the increasing number of child-headed
households. As the family structure changes, and parents and caregivers are
preoccupied with making a living or meeting social obligations, young people
often lack the guidance and support they need to make responsible life
decisions and yield easily to advice and misinformation from their peers.
The need to protect and maintain the family
system as the fundamental unit of Kenyan society cannot be over-emphasized.
Nevertheless, it is important that the rights of those adolescents who, for
various reasons, find themselves part of non-traditional family units be
protected as well.
3.5.4 Migration
Migration is a rational response of
individuals to real or perceived economic, social and political differences
between regions, or may result from such factors as prolonged drought that
deprives people of a source of livelihood or civil unrest that forces people to
flee their homes and communities. Some never return. As a rule, imbalances in
the levels of social and economic development, availability of social and
health amenities, perceived better standards of living, and population pressure
on existing local resources determine the level of population movements. In
Kenya, internal migration is dominated by rural to urban movements. Young
people, most of them school leavers in search of employment and other opportunities
in the urban centres, form the bulk of the rural to urban migrants.
3.6
Reproductive Health Information and Services
The World Health Organization states that
reproductive health (RH) is a state of complete physical, mental and social
well being, and not merely the absence of disease or infirmity, in all matters
relating to the reproductive system, its functions and processes.
In Kenya as in other parts of Africa, young
people face severe threats to their health and general well being. They are
vulnerable to sexual assault and prostitution, too-early pregnancy and
childbearing, unsafe abortion, malnutrition, female genital cutting,
infertility, anaemia, and reproductive tract infections (RTIs) including STIs
and HIV/AIDS.
Fertility levels have remained high among
Kenya's adolescents despite declines experienced among other age groups. Total
fertility rate (TFR) has declined dramatically, from 7.1 children per woman in
the mid-1970s to the current estimated level of 3.5 children per woman - a
decline of 42 per cent over a 20-year period. Age specific fertility rate
(ASFR) for 15-19 was 110/1000 in 1993 and 111/1000 in 1998; for the 20-24 age
group it was 257/1000 and 248/1000 in 1993 and 1998, respectively.
By comparison, in the age group 25-29, ASFR declined
from 241/ 1000 in 1993 to 218/1000 in 1997. Projections indicate that this
scenario will continue in the foreseeable future. The high fertility rate among
youth and adolescents is attributed to lack of access to needed RH information
and services, perceived hostility of service providers who at any rate lack the
appropriate skills for dealing with ARH problems, and a policy structure that
is inadequate for the needs of young people.
Sexual activity among Kenyan young people
begins early. It is, moreover, often characterized by what might be called
serial monogamy - one partner after another. Adolescent liaisons are usually
brief and easily replaced, so that by the time a person is ready to consider
settling into marriage they have already experienced many partners. Despite
this multiplicity of partners, sexual activity is usually unprotected, giving
rise to early pregnancy and unsafe abortion, school dropout, STIs including
HIV/AIDS, and economic hardship. According to KDHS 1998, 44 per cent of girls aged
15-19 years have had sexual intercourse and 19 per cent are sexually active.
The median age at first sex for men is 16.8 years, compared with 16.7 years for
women. Although men enter into sexual unions on average five years later than
women, they start sexual activity at about the same age.
In spite of high fertility and early sexual
debut, contraceptive use among adolescents is relatively low. Only 6.6 per cent
of persons aged 15-19 were using any method of family planning in 1998. Of
these, only 4 per cent were using modern methods. Among 20-24-year-olds, only
27 per cent were using any method while 19.9 per cent were using modern
methods.
Although government, private and NGO sectors
provide RH services, most are not designed to take into account the special
needs of young people. Where services exist, providers lack capacity to deal
effectively with adolescent reproductive health issues and the range of
services provided is also limited. Consequently, the majority of adolescents
are hesitant to use them. While emphasizing access to reproductive health
information and services, it is important to note that not all young people
have the same environmental or life experiences - for example, not all are
sexually active. Too many RH programmes for adolescents have left out the needs
of this group. The content of information and services provided must therefore
cater for the diverse needs of young people. There are those whose needs are
restricted to education, counselling, life-skills building, decision making and
negotiation skills to delay sexual debut, while others require a wide range of
clinical services.
3.6.1 HIV/AIDS and STIs
According to the National AIDS Control Council
(NACC) report 2002, an estimated 2.2 million Kenyans are infected with
HIV/AIDS, while 1.5 million Kenyans have already died from the disease. More
than 75 per cent of AIDS cases occur in adults between the ages of 20 and 45,
and since this is the most economically productive part of the population,
illness and death at these ages is a serious economic and social burden for the
family and the society. The peak ages for AIDS cases are 25-29 years for
females and 30-34 years for males. There is no significant difference between
infection rates in rural and urban settings.
Adolescents are more vulnerable to HIV/AIDS infection. Young women in
the age groups 15-19 and 20-24 years are more than twice as likely to be
infected as males in the same age group. It is estimated that about 20 per cent
of all reported AIDS patients are young people aged 15-24 years. Sexual contact
accounts for 80-90 per cent of all infections, while the rest is due to
exposure to infected blood and mother-to-child transmission. Mother-to-child
transmission is expected to increase because of the high incidence of HIV among
young women and will greatly affect infant and child mortality.
Kenya now has about 900,000 AIDS orphans, of whom about 78,000-aged 0-14
are infected with the virus. This number of orphans is projected to reach 1.5
million by the year 2005. Increases in the mortality rates of both children and
young adults will have a substantial impact on life expectancy at birth.
Sexually transmitted infections, especially
those that cause ulcerations to the genital area, significantly increase HIV
transmission rate - as much as 10 per cent . On the other hand, STIs are not
easily detectable amongst females, which becomes an intervention challenge.
3.6.2 Safe Motherhood
Safe motherhood aims at assisting all women to
go through pregnancy and childbirth with the desired outcome of a live and
healthy baby and mother. Current safe motherhood programmes include preventive
and health promoting activities encompassing family planning, antenatal care,
safe delivery, postpartum care and maternal nutrition. However, these services
are not equitably accessible to female adolescent users in all parts of the
country.
At the current estimate of 590/100,000 live
births, Kenya's maternal mortality rate is unacceptably high. Adolescents are
more likely to suffer pregnancy related complications than older women owing to
their relative immaturity as well as preventable causes such as malnutrition,
infectious diseases and haemorrhage, malaria, and inadequate health care and
supportive services, particularly in rural areas. A significant contributor to
maternal morbidity and mortality is unsafe abortion.
3.6.3 Reproductive Rights
Reproductive rights, embracing certain basic
human rights that are already recognized in Kenyan law and in international
human rights conventions and other consensus documents, have emerged as a
separate area of concern requiring attention. These include the right of the
youth to appropriate and relevant information and services. Furthermore, those
youth who are infected with HIV/AIDS have the right to receive health care
without being discriminated against because of their status. Denial of
reproductive rights to young people negatively affects their general well
being.
3.6.4 Unsafe Abortion
Unsafe abortion contributes significantly to
maternal morbidity and mortality. The majority of women seeking care for unsafe
abortion complications are below 25 years of age. Effective advocacy and
service provision to reduce the need for unsafe abortion are not adequate. The
promotion of knowledge and adoption of appropriate attitudes towards abortion
related issues will be enabled by this Policy. This includes correct and
adequate information where adolescents are found, as well as improved access to
contraceptive and post-abortion care services.
3.7 Harmful Practices
A number of social and cultural practices,
some rooted in traditional attitudes and some of more modern origin, have a
direct impact on the reproductive health activities and status of adolescents
and young people. Among those of most urgent concern to this Policy are early
marriage, female genital cutting (FGC), sexual abuse and violence, and drug and
substance abuse.
3.7.1 Early Marriage
Although the age at first marriage is rising,
early marriage is still prevalent in certain parts of the country. It is manifested
in the forced marriage of girls as young as 12 years to older men, as well as
more willing unions between young people. After marriage, these young
adolescents are compelled to leave school to take on the responsibility of
raising a family. This further limits their access to education and negatively
affects their economic development and general well being.
Women who marry early, whether by choice or by
force, are exposed to an early and longer period of childbearing. Young women
are more likely than older women to suffer pregnancy related complications.
3.7.2 Female Genital Cutting
Female genital cutting (FGC) remains prevalent
in Kenya. Over 60 per cent of communities in 49 districts still circumcise
their girls. As a result, nationwide 38 per cent of women in Kenya aged 15-49
are circumcised, while regional variations may range up to 90 per cent of women
in some communities undergoing the practice.
Complications arising from FGC include, but are not limited to,
haemorrhage, anaemia, cervical infections, (vesico-vaginal fistulae,) urethral
damage, urinary tract infections, excessive growth of scar tissue, dermoid
cysts, chronic pelvic infections, difficult and often dangerous childbirth, and
a variety of other complications that may even lead to death. In addition to
the physical effects, FGC also causes a range of sexual and psychological
problems for adolescent girls, significantly disempowering them both socially
and economically. FGC may also lead to girls dropping out of school to get
married. Recognizing that every human being has the basic right to physical
health and dignity, this Policy asserts that the practice of FGC is a violation
of this right.
3.7.3 Sexual Abuse and Violence
Data on sexual abuse and violence in Kenya are
limited. However, existing statistics show that 40-60 per cent of reported
sexual assaults are committed against girls aged 15 years and below. Although
both boys and girls can be victims of sexual abuse, girls are up to three times
more likely to be sexually abused than boys. Girls who suffer sexual abuse are
likely to begin sexual intercourse on average one year earlier and are much
more likely to become pregnant before the age of 17.
3.7.4 Drug and Substance Abuse
Drug and substance abuse remains one of the
major problems confronting the youth in Kenya today. Studies indicate that many
in and out of school adolescents, street children and other groups of
adolescents use and abuse drugs. Adolescents identified as being in most
vulnerable situations include sex workers, brewers and sellers of illicit
drinks, school dropouts, orphans, and young mothers. Most of the abusers are
deprived and poor, unemployed, students, and those in unstable families. The
most abused substances are tobacco and alcohol, khat (miraa), chang'aa (illicit
liquor), marijuana (bhangi), mnazi (traditional brew), glue, heroin and 'brown
sugar’.
Persistent drug use is associated with suicide
attempts. Like the users, most young people involved in trafficking and
peddling drugs are from poor and vulnerable groups. Studies indicate that there
is a close relationship among drug abuse, violence and reckless sexual
behaviour whose consequences include the spread of STIs and HIV/AIDS, unplanned
pregnancies, and sexual violence, among others. There are very few drug
rehabilitation programmes and counselling centres available for adolescents in
Kenya and these tend to be urban based.
3.8 Gender Perspectives
Gender is defined as the division of roles by sex, determined by any
given society and dictated by cultural, religious or other values that have
little to do with the anatomy or genetic construct of a person. Expectations
about what it means to be a man or a woman, which are an integral part of the
socialization process, leave many youth and adults ill prepared to deal with
their sexuality or protect their health. Gender influences sexual behaviour,
especially when stereotypical assumptions are considered.
Stereotypes of submissive females and powerful males restrict access to
health information, hinder communication between young couples, and encourage
risky behaviour among young women and men in different, but equally dangerous,
ways. Ultimately, these gender disparities increase adolescents' vulnerability
to sexual health threats such as violence, sexual exploitation, unplanned
pregnancy, unsafe abortion and sexually transmitted infections (STIs) including
HIV/AIDS. The power imbalances between men and women can sometimes make it
difficult for adolescent girls to refuse unwanted or unprotected sex, negotiate
condom use, or use contraception against a partner's or husband's wishes.
Although women comprise 52 per cent of the
total Kenyan population, and account for over 70 per cent of all food
production in Kenya, their contribution to social and economic development is
often unappreciated because it is not quantified in national economic terms.
This lack of appreciation of the role women play contributes to the existence
of huge gender disparities in literacy, educational attainment and economic
achievement. While the literacy rate for males aged 10 and above based on the
1999 census was 78 per cent, the rate for females of the same age was 70 per
cent. Although school enrolment at primary level is at par for girls and boys,
disparity increases at upper primary, secondary and higher education levels
owing to higher female dropout rates attributed to socio-cultural and economic
factors.
Low levels of educational attainment by women,
coupled with retrogressive socio-cultural practices, have resulted in low
participation and representation of women in decision-making positions and lack
of access to economic opportunities.
4.0 Strategic Actions for Adolescent and Youth Health
Adolescent and youth health is critical for
development. To this end, health information and services should be available,
accessible, affordable and acceptable. This Policy identifies the following
priority concerns:
i)
Adolescent
sexual and reproductive health and rights
ii)
Harmful
practices
iii)
Drug and
Substance abuse
iv)
Socio-economic
factors
v)
Adolescents
and youth with disabilities
To address these priority concerns, a series of specific strategic actions are proposed. These are itemized in the following sections.
4.1 Adolescent Sexual and Reproductive Health
and Rights
i) Provide appropriate sexual and reproductive
health information and services at all levels.
ii) Review existing or enact relevant legislation on reproductive health with a view to protecting adolescents and youth.
iv) Sensitize the various groups within communities on the protection of children's rights and the provisions and enforcement of the Children's Act.
v) Provide education to parents and the
community on the sexual and reproductive rights and health of adolescents and
youth.
vi)
Address gender
concerns in all sexual and reproductive health programmes.
vii)
Support programmes that encourage
adolescents and the youth to delay their sexual debut and practice abstinence.
viii)
Collect and analyse data for policy,
programming and service delivery.
ix) Strengthen capacities of
institutions, service providers and communities to provide appropriate
information and services such as post-abortion care, family planning (FP), and
maternal, antenatal and delivery services for adolescents and youth.
x) Promote appropriate
HIV/AIDS education programmes for adolescents and youth in and out of school.
xi) Advocate for behaviour change communication programmes by target
groups (10-14 years, in and out of school, married, disabled, displaced
including street children).
xii) Strengthen
the capacity of teachers, parents and leaders within
communities to provide appropriate information on HIV/AIDS.
xiii) Promote adolescent
involvement and participation in planning, decision-making, implementation and
management of adolescent sexual and reproductive rights and health programmes.
4.2 Harmful Practices
i) Advocate for raising the legal age at marriage for both
women and men from 16 years to 18 years.
ii) Support research on harmful practices to guide appropriate
interventions while monitoring trends.
iii) Reduce prevalence of harmful practices through appropriate
policies, legislation, programmes and enforcement.
iv)
Enhance protection of girls through
enforcement of the Children's Act at all levels.
vi)
Reinforce mechanisms for justice
and provision of legal assistance.
vii)
Strengthen the capacities of
institutions, communities, families and individuals to prevent harmful
practices.
viii) Enhance measures to
protect young people in penal institutions from sexual abuse.
4.3 Drug and Substance Abuse
To counter this anti-social behaviour the following strategic actions
are proposed:
i)
Promote
education on the dangers of drug and substance abuse among adolescents and
youth through in- and out-of-school programmes.
ii)
Establish
support services at all levels for adolescents and youth exposed to drug and
substance abuse.
iii) Advocate for enforcement of legislation governing the access by adolescents and minors to tobacco, alcohol and psychoactive substances in the country.
iv) Advocate
for the enforcement of the liquor licensing act.
4.4 Socio-Economic Factors
Family stress and
the erosion of traditional values and support systems, noted earlier, often
mean that young people have no role models and little guidance in terms of
responsible sexuality and reproductive health. Besides, rising poverty levels
are influencing the performance of the education sector, constraining
employment opportunities and limiting access to basic human needs including
nutrition and shelter. Too often young people have few options and no place to
turn for reliable advice and support.
To respond to these factors the following strategic actions are
proposed:
i) Encourage youth
participation and involvement in planning, implementing, monitoring and
evaluating projects and programmes addressing their needs.
ii)
Support the development and
implementation of programmes to address children and youth in difficult
circumstances.
iii) Support poverty reduction
strategies.
iv) Support
school enrolment and completion at all levels.
v) Advocate
for enforcement of the return to school policy and a social support system for
girls after pregnancy.
vi)
Address gender
disparities in the education sector.
vii)
Strengthen the
capacity to impart knowledge about nutrition through various channels at all
levels.
viii) Strengthen the capacity of the line ministries including, for example, Ministry of Health, Ministry of Labour and Human Resource Development, Ministry of Gender, Sport, Culture and Social Services, and other relevant ministries to monitor and enforce appropriate laws.
ix)
Support
livelihood programmes and schemes for adolescents and youth.
x)
Support
institutional capacities to provide mental health programmes.
4.5 Young
People with Disabilities
Persons
with disabilities are generally a marginalized group. The problem is further
compounded if they are adolescents or youth. To address their needs the
following strategic actions are proposed:
i) Promote
disaggregated data collection, analysis and use in programming.
ii) Enhance the capacities of institutions, individuals and
teachers to respond to the special needs of adolescents and youth with
disabilities.
iii) Ensure
support for community-based programmes for adolescents and youth with
disabilities.
iv) Support
establishment of appropriate recreational and other user friendly services for
adolescents and youth with disabilities.
v) Promote
access to reproductive health information and services for adolescents and
youth with disabilities.
5.0 Goal , Objectives and
Targets
The goal of this Policy is to contribute to the improvement of the
well-being and quality of life of Kenya's adolescents and youth. The Policy seeks to integrate their health
and development concerns into the national development process and to enhance
their participation in that process.
5.1 Objectives
i) To identify and define adolescent
health and development needs.
ii) To provide guidelines and strategies to address adolescent health concerns.
iii)
To promote partnership among
adolescents, parents and community. iv) To create an enabling legal and
socio-cultural environment that promotes provision of information and services
for adolescent and youth.
v) To promote and protect adolescent
reproductive rights.
vi)
To strengthen inter-sector
coordination and networking in the field of adolescent health and development.
vii)
To promote participation of
adolescents in reproductive health and development programmes.
viii) To identify and define monitoring and
evaluation indicators for ARH&D.
ix)
To advocate for increased resource
commitments for adolescent and youth health and development programmes.
5.2 Targets
The targets that will guide the Adolescent
Reproductive Health and Development Policy and its programme planning up to the
year 2015 are in the areas of health, demographics and social services. They
are detailed below.
5.2.1 Health Targets
i) To double the
contraceptive use rate among adolescents (aged 1519 years) from 4 per cent in
1998 to 8 per cent in the year 2015, and among youth (20-24 years) from 19.9
per cent to 40 per cent during the same period.
iii) To
increase the proportion of facilities offering youth-friendly services from
baseline to 85 per cent by 2015.
iv) To increase the proportion of mothers below age 25 receiving
at least two doses of tetanus toxoid during pregnancy from 25 per cent to 85
per cent by 2015.
v) To
increase antenatal attendance by mothers below age 25 from the baseline to 85
per cent by 2015.
vi) To
increase the proportion of mothers below age 25 delivering in a health facility
from baseline to 60 per cent by 2015.
vii) To
increase the minimum antenatal care visits by mothers below age 25 from
baseline to 80 per cent by 2015.
5.2.2 Demographic Targets
i) To reduce the
proportion of women aged below 20 with a first birth from 45 per cent in 1998
to 22 per cent by the year 2015.
ii)
To raise the median age at first
sexual intercourse from 16.7 for girls and 16.8 for boys to 18 for both by
2015.
iii)
To reduce the maternal mortality
ratio by 50 per cent in the 15-24 age group by 2015.
5.2.3 Social Services Target
i) To achieve universal primary education
(UPE) by 2003 and Education For All (EFA) by 2015.
ii) To achieve gender equity in education by
2015.
6.0
Implementation Strategies
The following strategies will be applied to achieve the goals and
objectives of this Policy:
In order to bring
about change in policy and resource allocation necessary for its
implementation, this Policy will provide for advocacy programmes to be under
taken. These programmes will target policy makers, elected religious leaders
and opinion leaders. They will aim to increase awareness of the importance and
impact of adolescent and youth health needs at individual, family, community
and national levels.
i) Advocacy
ii)
Behaviour change communication
iii) Provision of reproductive health services
iv)
Research
v) Capacity building
vi)
Resource mobilization
vi)
Networking
and participation
vii)
Monitoring
and evaluation
6.1 Advocacy
In order to bring about change in policy and resource allocation
necessary for its implementation, this Policy will provide for advocacy
programmes to be under taken. These programmes will target policy makers,
elected religious leaders and opinion leaders. They will aim to increase awareness
of the importance and impact of adolescent and youth health needs at
individual, family, community and national levels.
6.2 Behaviour
Change Communication (BCC)
Young
people must learn that they are ultimately responsible for their own actions
and that it is they who must live with the results of poor decisions.
Programmes here will include life skills training to help them assess
situations and possible outcomes, as well as efforts to help them identify
risky behaviour and its consequences.
6.3
Provision of Adolescent-Friendly Reproductive Health Services
To improve the utilization of health services
by adolescents, efforts will be made to address factors that affect
accessibility and quality of care, such as provider attitudes, privacy,
confidentiality and hours of service.
6.4 Research
Research forms an important component to inform and identify gaps in
the implementation of this Policy.
6.5 Capacity Building
Efforts
will be made to strengthen capacities of youth, parents, teachers, community
members, religious and political leaders, service providers, relevant
institutions, and other stakeholders in order to respond to the needs of
adolescents and young people.
6.6 Resource
Mobilization
Mobilization of significant financial, human,
material and technical resources is required to attain the goal and objectives
of this Policy. This responsibility will be shared by all stakeholders (NGOs,
private sector, religious organizations, communities). The Government, through
the Ministry of Planning and National Development and the Ministry of Health,
will provide leadership and coordination in resource mobilization activities.
6.7
Networking and Community Participation
The successful implementation of this Policy
will require concerted efforts by all stakeholders. These include the
Government, non-government organizations, donor agencies, community-based
organizations, leaders, communities, parents and young people themselves.
6.8 Monitoring and Evaluation
The implementation of this Policy will be
facilitated through the development of a comprehensive plan of action. Its
success will depend on the commitment and activities of all stakeholders
involved in its implementation. A monitoring and evaluation framework will be
developed to assess the progress towards achieving the set goals and
objectives. The Ministry of Health in collaboration with NCPD will develop
guidelines for regular reporting of activities by implementing line ministries,
districts, institutions and NGOs. NCPD will prepare annual reports as well as
arrange special impact assessments and any other relevant studies from time to
time.
Institutional Framework
7.0 Institutional Framework
Given that addressing adolescent reproductive
health and development issues requires a multi-sector approach, several government
ministries and agencies will be involved in the implementation of this Policy.
The Ministry of Health (MOH) is responsible for the coordination and
implementation of all health activities and programmes in the country and will
be the primary implementer of the Policy. The National Council for Population
and Development (NCPD), as the organization mandated to coordinate all
population and family planning activities in Kenya, will be the co-implementer.
7.1 Implementation Responsibilities
As the lead agencies responsible and answerable for the implementation
of this Policy, MOH and NCPD will:
i) Advocate, promote and coordinate the implementation of the Policy at both national and sub-national levels.
ii)
Review and recommend appropriate
changes in the adolescent health focus in the country and advise the government
accordingly, taking into consideration the political, economic, socio-cultural
and legal realities in the country.
iii)
Advise the government on resource
mobilization and the monitoring of their use to support the implementation of
the Policy.
iv) Undertake any other
relevant activities that could promote sustainable adolescent health programmes
to improve the well-being of young people in Kenya.
At the district level, the District Health
Management Teams will incorporate other relevant government departments, NGOs
and the private sector into their committees responsible for overseeing the
implementation of the Policy.
These committees will:
v) Advocate for the recognition of adolescent sexual and reproductive health (ASRH) issues at the district level.
vi)
Ensure the promotion, coordination,
monitoring and evaluation of adolescent health programmes and activities in the
district.
vii)
Ensure the integration of ASRH
issues in all development activities at the district level.
viii) Promote collaboration
among government departments and NGOs involved in youth activities, thereby
providing a link with the national level programmes.
ix)
Mobilize resources at the district
level.
x) Compile district level reports on
adolescent health programmes and submit reports to the national office.
7.2
Roles of Government Ministries and
Agencies
The expected broad roles of some of the government ministries as well as
other agencies are outlined briefly below.
7.2.1 The Office of the
President
i) Integrating and
incorporating ARH&D issues into development projects through the District
Development Committees (DDC) and the Provincial Administration.
ii) Ensuring that
ARH&D issues are mainstreamed into the functions of specialized
subcommittees of the DDC, especially the District Population and Family
Planning Committees (DPFPC), Poverty Eradication Committees, and Constituency
Based AIDS committees.
iii) Using the Provincial
Administration, particularly Chiefs and Assistant Chiefs, to act as ARH&D
advocates and as agents of change towards a more positive attitude to the
provision of reproductive health information and services to adolescents.
iv) Expanding coverage of
civil registration and providing data on births and deaths and other vital
statistics and disaggregating them to illuminate the impact of various social
and reproductive health problems on adolescents and the country.
v)
Ensuring that ARH&D concerns
are fully considered in the plans and programmes of the National AIDS Control
Council.
vi) Developing programmes
that provide population and reproductive health information, counselling and
services to young people in the armed services and police force.
7.2.2 Ministry of Home Affairs and National
Heritage
i) Integrating HIV/AIDS and reproductive health education and
guidance and counselling into programmes to cater for children living under
difficult circumstances.
ii) Developing programmes that provide
population and reproductive health information, counselling and services to
young people in prison, remand homes and other penal institutions.
7.2.3 Ministry
of Gender, Sports, Culture and Social Services
i) Integrating into
Community Youth Polytechnics and vocational training programmes information
about population, adolescent reproductive health and development issues.
ii) Encouraging folk media and modern theatre productions on themes related to reproductive health, family planning, population and development, and ensuring young people are directly involved in such productions.
iii) Examining traditional cultural values and practices that promote and support adolescent reproductive health.
iv)
Providing supportive systems to
girls who drop out of school because of pregnancy.
v) Promoting ARH messages through sports.
vi)
Strengthening population and
reproductive health issues under adult literacy activities, with youth-specific
modules.
7.2.4
Ministry of Justice and Constitutional
Affairs and the State Law Office
i) Providing legal guidance and
facilitating enactment of necessary laws on matters concerning adolescents and
reproductive health.
ii)
Revising and enforcing relevant
laws to provide adequate protection to juveniles, orphaned adolescents and
children in difficult circumstances.
iv) Revising the law on rape to reduce the reporting burden on
adolescent and child victims of rape and providing equally severe punishment
for the crime of defilement as for rape.
v)
Enforcing the Dangerous Drug
Addicts Law and laws against substance and drug peddlers.
vi)
Conducting research into
legislative needs and requirements of the country in respect to all matters of
adolescent health and well-being.
7.2.5 Ministry of Health
The Ministry of Health's Division of Primary
Health Care is one of the principal implementers of this Policy. This office
will carry out its responsibility by:
i)
Coordinating and implementing
reproductive health programmes including family planning and ensuring that
ARH&D concerns are fully integrated into all such programmes.
ii)
Implementing and coordinating
adolescent health aspects of STI/HIV/AIDS programmes.
iii)
Producing and disseminating health
and education information, messages and materials with special emphasis on
ARH&D.
iv)
Providing appropriate information
to young people and enhancing awareness of issues related to smoking and
consumption of alcohol and harmful drugs.
v) Training health
personnel at all levels and ensuring that adolescent reproductive health is
integrated into the training curricula of all medical and paramedical
personnel.
vi)
In liaison with other agencies,
carrying out research on adolescent reproductive health issues.
vii) Developing a strategic
plan on adolescent reproductive health that will guide the implementation of
the health aspects of this Policy within the government and private health
services framework.
viii)
Ensuring the provision of
adolescent-friendly reproductive health information and services at all
government health facilities.
7.2.6 Ministry of Planning and
National Development
NCPD's mandate is to advise and guide all
ministries in matters pertaining to population and development. This will now
include the implementation of this Policy as well as all ARH&D projects and
activities or components of the same in population and reproductive health
projects. In addition to the specific activities of NCPD, the Ministry of
Planning and National Development will be responsible for:
i)
Ensuring sufficient budgetary allocation for adolescent reproductive health
activities commensurate with the numbers and importance of this population age
group, and enforcing full accountability of the expenditures.
ii) Mobilizing local and
international resources to support adolescent and youth programmes, especially
on such critical issues as mitigating the impact of the HIV/AIDS epidemic.
iii) Integrating and
mainstreaming ARH&D issues into development planning at all levels, with
special emphasis on the impact of HIV/ AIDS.
iv) Providing demographic data to all
ministries, NGOs and other agencies and assisting in conducting surveys and
research.
v)
Providing the relevant population
information disaggregated by age and district, division and location levels.
7.2.7 Ministry
of Education, Science and Technology
i)
Continuing
to review and integrate HIV/AIDS education at all levels of the education system.
ii)
Ensuring
the integration of reproductive health education into the curricula at all
levels of the education system.
iii)
Mobilizing
individual and organization support for the implementation of ARH&D and
population education programmes.
iv)
Supporting
population and ARH&D research programmes and integrating reproductive
health education into the non-formal training programme.
7.2.8 Ministry of Tourism and Information
i) Using their facilities and
infrastructure to inform and educate people about ARH&D issues, and their
implications.
ii) Providing a voice for
the articulation of ARH&D issues to the public and other stakeholders
through government media and broadcast services.
iii) Developing publicity
programmes that demonstrate the impact on national development of a high population dependency ratio, a high proportion of youth in the population and related issues, and the role of government, NGOs, and other agencies and individuals in combating the
negative impact of such problems.
iv)
Taking decisive steps to minimize
'sex tourism’ especially as it relates to young people.
7.2.9
Ministry of Environment, Natural
Resources and Wildlife
i) Establishing programmes
to educate the youth about the environment as a 'good' that has value, and can
appreciate or depreciate. Consequently, programmes to create awareness on
prudent environmental management such as proper waste disposal, guarding
against environmental degradation and depletion of natural resources as a
direct result of excessive population should be initiated by
the ministry.
ii)
Developing population and
environmental education themes and materials for incorporation into all
training programmes.
7.2.10
Ministry of Agriculture and Livestock
Development
i) Integrating population and reproductive health education activities into the training programmes of agricultural extension workers in order to equip them with the relevant skills for relating these issues to food production and consumption and other development activities at the local level.
ii) Developing programmes
to highlight the impact of a growing youth population on the provision and
delivery of adequate food for the country.
7.2.11
Ministry of Labour and Human Resource
Development
i) Continuing to provide information on primary health care including family planning and ARH&D at places of work.
ii)
Advocating for the provision of
childcare services to women at the places of work.
iii)
Developing programmes aimed at
protecting adolescents from exploitation and abuse at the place of work.
7.3 Roles of Non-Government
Entities
The implementation of this Policy will require
the full cooperation of a wide range of interested parties, including NGOs,
community-based organizations (CBOs) and the private sector, as well as
religious institutions, families and communities, mass media, and young people
themselves.
7.3.1 NGOs, CBOs and the Private Sector
As important potential partners in the implementation of this Policy,
supplementing the inputs of Government Ministries and departments, the role of
these groups will include:
ii) Providing
IEC materials that are culturally sensitive, comprehensive and inclusive of all
relevant issues such as sexuality, STD/HIV/AIDS, unwanted pregnancies and early
childbearing, unsafe abortion, contraceptives, responsible behaviour, etc., for
special groups like parents, teachers, religious institutions, service
providers and others.
iii) Carrying
out research on issues of relevance to the implementation of this Policy and
sharing these findings with both government and non-government partners.
iv) Providing
technical support in the training and re-training of existing health care
service providers on the management of adolescent reproductive health problems
to enhance the provision of youth friendly services.
v) Building the capacity of adolescents to
manage ARH&D programmes and to demand their own rights to access to quality
services and information on reproductive health.
vi)
Mobilizing resources for ARH&D
programmes.
vii)
Acting as watchdogs to ensure this
Policy is implemented at all levels of the society.
7.3.3 Religious Institutions
i) Providing moral and spiritual guidance
in the implementation of this Policy and any programmes that will follow from
it.
ii)
Providing counselling, information
and services in the field of adolescent sexuality consistent with their
religious beliefs.
7.3.4 The Family and the
Community
i) Continuing with the
traditional role of supporting, socialization and moulding of the lives of
adolescents, while recognizing emerging socio-economic and cultural challenges.
ii) Advocating, promoting,
and supporting the implementation of this Policy and programmes and the
provision of information and services to the youth.
7.3.5 Mass Media
i)
Producing
and serializing programmes and features on adolescent reproductive health and
development.
ii)
Ensuring
that issues of adolescent health and well-being are kept in the forefront of
public consciousness through regular debates, features and critiques on programmes, policies and actions of the
various players in this field.
iii) Providing
adequate space and airtime for the coverage of adolescent and youth reproductive
health issues commensurate with the important position of this population age
group in national development.
iv) Censoring
pornographic entertainment, as it negatively affects the sexual behaviour of
young people, who tend to imitate what they see, hear and read. Such
'entertainment' is also a hindrance to behaviour change programmes.
7.3.6 Young People
i)
Advocating, promoting and
supporting the implementation of this Policy.
ii) Seeking appropriate
information for themselves as young people and enhancing awareness of issues
related to consumption of alcohol and harmful drugs.
iii) Mobilizing
individuals, other young people, leaders and the community to support the
implementation of the Policy using existing structures in folk media and modern
theatre.
iv)
Articulating adolescent
reproductive health issues to the public and other stakeholders.
v) Taking the initiative
to make responsible life decisions and positively change their sexual and
reproductive health behaviours.
vi)
Supporting fully the integration of
youth issues into the social, legislative and policy development agenda.
vii) Helping to mobilize
and sensitize the community on reproductive health aspects that affect
adolescents and draw support for the same.
viii)
Advocating for the
eradication of harmful social-cultural practices that affect the youth.
ix)
Seeking and using ARH counselling,
information and services.
7.3.7 Political Parties
i) Supporting fully the integration of
youth issues into the social, legislative and policy development agenda.
ii)
Ensuring that the issues of youth,
including ARH&D, are well articulated in their manifestoes, programmes and
plans.
iii)
Helping mobilize and sensitize the
community on reproductive health aspects that affect adolescents and drawing up
support for the same. iv) Providing for the direct participation of young
people in political, economic and government power structures.
7.3.8 Universities and Colleges
i)
Providing
training on adolescent health, family planning, and population and development.
ii)
Carrying
out research on population, ARH&D, and related issues.
iii)
Conducting
focused research into such little-understood areas as: the sexuality needs of
handicapped young people and those living in difficult circumstances, incest,
homosexual youth behaviour, etc., and providing for the wide dissemination of
such findings.
iv)
Providing
consultancy and advisory services to youth organizations, NGOs and Government
on adolescent reproductive health and development.
8.0 Conclusion
The health concerns of young children, adults and the elderly have
hitherto taken precedence over the needs of adolescents. This Policy is an effort to highlight
adolescent health issues and bring them into the mainstream of health and other
social services. Young people form a critical national resource for today, and
the core of our future development efforts. Their health is a worthwhile
investment for future growth and development.
Young people have great potential to
contribute to the process of decision making and the implementation of
programmes for their own benefit as well as the development of society at
large. The understanding, adoption and implementation of this Policy will
contribute positively to the efforts to emancipate young people and integrate
them into social development efforts. All persons and organizations with a
stake in the lives and health of adolescents are urged to take special
consideration of this Policy and its ideals in their day-to-day work.
Glossary
Contraceptive prevalence rate: The percentage of married women of
reproductive age (15-49) who are using any method of family planning, whether
modern or traditional, to space or limit births.
Gross enrolment rate (GER): Statement of the total number of children in
school in standard 1-8, divided by the total number of children aged 6-13, and
multiplied by 100.
Infant mortality rate (IMR):The number of deaths of infants under one year of age per 1,000 live births
in a given year.
Life expectancy: Average
number of years a person would live if the current mortality trends were to
prevail.
Maternal mortality rate (MMR): The number of deaths of women resulting from
pregnancy and birth complications per 100,000 live births in a given year.
Reproductive health*: State of complete physical, mental and social
well-being and not merely the absence of disease or infirmity, in all matters
relating to the reproductive system, its functions and processes.
Reproductive rights: Rights, embracing certain basic human rights that are already recognized
in Kenyan law and in international human rights documents and other consensus documents, that have emerged as a
separate area of concern requiring attention. These include the right of the
youth to receive adequate information on family planning and the right of couples
to determine responsibly and freely the number of children they would want to
have and how to space them. They also include the right of HIV/AIDS infected
individuals to receive health care without being discriminated against due to
their state, and the right of the spouse or partner to know that their spouse
is infected. Reproductive rights embrace the medical protocols regarding
consent and confidentiality. The National Policy for Population and
Sustainable Development makes it dear that abortion will not be used as a
method of family planning in Kenya and every attempt will be made to eliminate
the need for abortion through reliable information, counselling and services
Safe
motherhood. A concept whose aim is to
assist women to achieve safe pregnancy and delivery leading to healthy babies
of healthy mothers.
Sexual
health and rights; Sexual
health aims at the enhancement of life and personal relations, and sexual
health services should not consist merely of counselling and care related to
reproduction and sexually transmitted diseases. Sexual rights include the human
rights of all persons to have control over and decide freely and responsibly on
matters related to their participation in and enjoyment of sexual and
reproductive health free of coercion, discrimination and violence.
Total
fertility rate (TFR):
The number of children that
would be born alive to a woman during her lifetime, taken as an average of a
given group of women.
Unmet
need: Term used in the
context of family planning in this Policy. A married woman of reproductive age
will be said to have unmet need for family planning if she wants to either
space or limit births and is not using any method of family planning.
*World Health
Organization definition