Comprehensive Sexual education in Kenya has been a topic of concern in recent years. The question of whether youth in Kenya are equipped with comprehensive sexual education has been raised by many stakeholders in the education sector. Responding to a recent article published by Nation Africa, the United Nations Population Fund (UNFPA) Director Technical Division Julitta Onabanjo said Kenya has withdrawn from the Eastern and Southern Africa (ESA) ministerial commitment to comprehensive sexuality education.
This comes after the Kenya Demographic and Health Survey (KDHS) 2022 revealed in January that almost half of Kenyan adolescents aged 15-17 years do not know how to protect themselves from HIV/AIDS. Moreover, the percentage of girls and young women aged 15–19 years who have ever been pregnant is highest in Samburu (50%), West Pokot (36%), Marsabit (29%), Narok (28%), Meru (24%), Homa Bay (23%), Migori (23%), Kajiado (22%), Siaya (21%), and Baringo (20%), and lowest in Nyeri and Nyandarua (5% each).
Jane* (not her real name) is among the 41.6% of teenage girls aged between 15 -19 years who are sexually active and are not using any contraceptive according to the KDHS 2022. According to KNBS, only 11% of sexually active teenagers in Kenya are using contraceptives to prevent unintended pregnancies.
Jane falls under the other 89% who do not use birth control but are sexually active. These teenagers lack basic information on their sexual and reproductive health. Jane, 17, who requested anonymity to speak freely, told The Elephant that she regrets her first sexual encounter, which happened in the dormitory with a boy in her school. She did it because of peer pressure.
“My friends were talking about it and how good it feels, so I wanted to fit in,” she disclosed.
Jane, however, said that she is not well-informed about safe sex and protecting herself against unintended pregnancy, HIV/AIDS and other sexually transmitted infections.
The little she knows has been gleaned from brief conversations with her mother, Sarah Nekesa, a single mother living in an informal settlement, who has on occasion mentioned that there is a right time to have sex. Jane’s mother has also advised her to use protection if she can’t wait for the “right time.”
Moreover, Jane’s mother has also told her that if she has a boyfriend, they should be tested (for HIV) before engaging in sex. However, her mother discourages her from using contraceptives at her age, which she says is too young. As far as her mother who is staunch Christian is concerned, there is only one way that Jane can protect herself from getting infected or even pregnant—abstain from sex. What she does not know is that, apart from the incident in school, Jane has been engaging in transactional sex for several years. “I started sleeping with men who would give me money to buy pads and other essentials which my mother could not afford to give me,” Jane says.
“I could never talk to my mother about sex. I only did what I saw other friends my age do. After sex, I would take the morning-after pill (P2) to avoid pregnancy. The pills had some side effects. I experienced stomach pain and blood in the urine so I had to stop such activities. I didn’t use any protection, it is a relief I’m in good health,” Jane narrated.
A 2015 study by Guttmacher in three counties, namely Nairobi, Mombasa and Homa Bay found that most students in Forms 2 and 3 (96%) had received some sex education by the time they completed primary school, but the information received at this level is basic and does not include information on safe sex. Messages conveyed are often conservative and focused on abstinence. For instance, six in 10 teachers strongly emphasised that sex is dangerous and immoral and two-thirds strongly emphasised that abortion is immoral. Students said that the lessons focus on reproductive physiology and HIV prevention, and only 2% said they learnt all topics that constitute a comprehensive curriculum (including values and interpersonal skills, gender and sexual and reproductive health rights, contraception and unintended pregnancy).
Many curricula fail to provide adequate information about modern contraception – particularly, but not limited to, emergency contraception and female condoms – or HIV prevention through PrEP and PEP.
The inadequacy of education of children in practical matters of contraception and intercourse is often based on the belief that this information will encourage promiscuity, yet most students (93%) say sex education would be useful or very useful to their personal lives.
Yet abstinence-only programmes are still delivered in many countries despite robust evidence that this approach is ineffective. An increasing number of teen pregnancies in Kenya indicates that abstinence-only programmes are not effective. According to guidelines on sexuality education authored by six UN bodies (UNESCO, UNAIDS, UNFPA, UNICEF, UN Women and WHO), abstinence-only programmes are more likely to contain incomplete or inaccurate information regarding topics such as sexual intercourse, homosexuality, masturbation, abortion, gender roles and expectations, condoms and HIV.
The fact that Jane is sexually active but unaware of safe sex shows the risks that adolescents, especially girls who bear the brunt of teenage pregnancy, HIV infections and sexual and gender-based violence, face in the absence of comprehensive education about healthy sexuality.
A study conducted in Western Kenya in 2018 estimated that among 2.8 million girls aged 15-19 years, 24% (665,000) were sexually active and did not want a child, but were not using a modern contraceptive method. This age group accounted for 86% of all unintended pregnancies in the country.
Some of these girls are survivors of gender-based violence, including child marriage. United Nations Population Fund (UNFPA) estimates that Kenya’s child marriage prevalence rate is 23%. Child marriage is a driver of low education attainment, in turn limiting the employment and life options of girls. On the flip side, low education attainment also drives child marriage, fueling a vicious cycle.
These girls are further exposed to sexually transmitted infections. A study conducted in 2011 in the Rift Valley and Coast regions among HIV-positive adolescents aged 15-19 years found that about half had ever been tested and only a quarter of them knew their HIV status. Moreover, among sexually active HIV-positive adolescents, only a quarter reported using condoms at their first sexual intercourse. The study further found that two-thirds of HIV-positive girls had already begun childbearing or were pregnant, while 27% of boys had impregnated someone. In addition, 75% of pregnancies among HIV-positive girls were reported as unintended.
To equip young people with the information and skills needed for healthy sexuality in adulthood and to protect themselves from the risks that come with a lack of accurate and comprehensive information, UNESCO recommends that information on the cognitive, emotional, physical and social aspects of sexuality be included in the school curriculum. According to UNESCO, comprehensive sexuality education aims to equip children and young people with knowledge, skills, attitudes and values that will empower them to: realise their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and, understand and ensure the protection of their rights throughout their lives.
Further, the Constitution of Kenya guarantees the right to the highest attainable standard of healthcare, including reproductive health, and the Health Act provides for an overarching legal framework for health. The law clearly supports Kenya’s commitments to the regional push for rights-based CSE in 2013, which includes several key goals. The ESA commitment calls for scaling up access to and quality of comprehensive sexuality education, increasing access to youth-friendly sexual and reproductive health services, eliminating all HIV infections, reducing early and unintended pregnancies, and eliminating gender-based violence and child marriage. These commitments are now on hold following Kenya’s withdrawal.
Comprehensive sex education has been opposed by various campaigners, such as the Commission for Education of the Kenya Conference of Catholic Bishops (KCCB) headed by Bishop Paul Njiru Kariuki. One of their campaigns titled Stop CSE said that the curriculum “is one of the greatest assaults on the health and innocence of children.”
The opposition to CSE, however, ignores clear evidence that CSE has a positive impact on sexual and reproductive health, notably contributing to a reduction in sexually transmitted infections, HIV and unintended pregnancy. CSE also improves knowledge and self-esteem, changes attitudes and gender social norms, and builds self-efficacy.
Purity Ngina, the evidence manager at Zizi Afrique Foundation, who recently completed a two-year survey of 17,000 teenagers aged 13-17 years in Kilifi County, said the survey revealed that only 16% have awareness of sexual and reproductive health.
“Many young boys think they can’t interact with girls because it is wrong and they will impregnate them. Lack of guidance and misinformation highly contributes to young people engaging in risky behaviours,” she said, adding that teenagers need to be trained to build decision-making and problem-solving skills, so they can make healthy decisions concerning their sexuality.
Ms Ngina added that the dissonance between what children are taught in church or at home and scientific information only leaves them confused.
“We hope that someone will use the Bible to train them on good morals and how our bodies change, but there is incongruence between science topics and what the adolescents are taught in church or by their parents at home,” she said.
Given the benefits of CSE on sexual and reproductive health, especially in reducing STIs, HIV and unintended pregnancy, it is vital for adolescents to receive proper education during this period of significant growth and development, filled with vulnerabilities. A good education presents a unique opportunity to foster better health outcomes as adolescents’ experiences likely shape their health behaviour throughout their lives. A 2020 study found that CSE programmes are highly effective, cost-effective and may even be cost-saving, especially if they are intra-curricular, nationally rolled out and jointly delivered with youth-friendly services.
This was evident in the results of a pilot study of more than 6,000 students who received sex education. The 2014 study noted a demonstrable increase in HIV knowledge, contraception and condom use among the sexually active, and a reduction in risky sexual behaviour among students. Students who received sex education also reported delayed sexual initiation compared to those who did not.
Evidence of the benefits of CSE is clear, but what will it take for it to work in a country like Kenya?
Ibrahim Okumu, a secondary school teacher says that, for one, the focus should not be on abstinence-only and that education policies that are overreliant on abstinence-only education should be reviewed.
“We are trying to tell our students to abstain but this is becoming more difficult,” he said in a YouTube video on video published by Citizen TV.
According to human rights advocate Wangui Gitahi, Kenya should also renew its official commitment to ESA, and implement its promise to expand comprehensive rights-based sexuality education.
There is also a push for CSE to be a stand-alone subject and not integrated into other subjects as is the case currently. Research from four low and middle-income countries including Kenya, published in PLOS pointed to the drawbacks of an integrated approach. For instance, teachers trained in their primary subject areas are rarely taught how to integrate CSE and might easily skip over topics they consider controversial with the excuse that they do not have adequate knowledge to cover them. Moreover, integration can diminish the importance of CSE in the curriculum as it gets diluted and doesn’t wield the weight of a standalone subject for both teachers and students.
Implementing CSE also requires resources, and the lack of dedicated funding for CSE from governments has posed a challenge. Historically, funding for CSE has been piecemeal, mainly from external sources, and tied to specific projects. Moreover, there is a lack of coordination of the various efforts by central and local government, NGOs and development partners; and inadequate systems for monitoring and evaluating teachers and students on CSE. Curriculum implementation-related challenges included inadequate weight given to CSE when integrated into other subjects, insufficient adaptation of the curriculum to local contexts, and limited stakeholder participation in curriculum development.
Easther Mwema a youth activist from Zimbabew who runs a sexual and reproductive health data collection centre recommends that youth should be included as stakeholders in the discussions on comprehensive sex education.
“Growing up, there were lots of situations that made me feel very unsafe as a female. But I was never asked what I would like to do about them, or what I could do to protect myself. All policies related to sexual education and rights are made by adults. That’s not right. I think youth should be in the room when decisions are being made about their bodies,” she said in an interview with Hivos.
Why CSE works in some countries and not others
As Kenya faces roadblocks in CSE implementation, South Africa’s Department of Basic Education DBE expanded the Comprehensive Sexuality Education curriculum in the Life Orientation subject.
South Africa’s HIV incidence rates are highest among adolescent girls and young women (AGYW), accounting for an estimated 29% of all new infections in 2018. HIV prevalence among girls aged 15–19 years was 5.8%, and 4.7% among boys in 2017. Birth rates have decreased moderately from 78 births per 1000 in 1996 to 65 births per 1000 in 2016 among the 15–19 age group. However, these birth rates remain high with data revealing that the majority of girls who become pregnant while attending school often do not return after childbirth, and in instances where girls do return to school, they face challenges balancing school and childcare.
In response, the SA Department of Basic Education (DBE) developed the HIV, STI, and TB policy, which included the call to educate girls and boys about sexuality and sexual behaviour in an effort to reduce both unintended pregnancy and HIV rates. One of the key interventions pronounced in this policy is the provision of comprehensive sexuality education (CSE). The aim of CSE, as specified by the DBE, is to build and shape learners’ understanding of concepts, content, values, and attitudes around sexuality and sexual behaviour.
Since 2015, the DBE has developed and piloted Scripted Lesson Plans (SLPs) across five provinces (KwaZulu-Natal, Free State, Gauteng, Mpumalanga, and Western Cape) to strengthen the teaching of CSE in schools. These support materials aid educators and improve the effectiveness of CSE lessons. This formed part of the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) initiative, which aimed to reduce HIV infection among young women. The delivery of CSE using SLPs forms part of the DREAMS package of “layered” evidence-based HIV prevention interventions targeting biological, behavioural, and structural factors to reduce the vulnerability of girls and young women to HIV with the aim of reducing HIV incidence by 40% among adolescent girls and young women over a two-year period (2016–2018).
According to Hivos.org sex education increases the level of sexual responsibility among adolescents, as they gain essential knowledge and skills that will benefit them in adulthood. Currently, because of inadequate sex education, many adolescents and teenagers are uninformed. The myths and misconceptions about sex prevail among them.
In countries like the Netherlands where children learn about relationships from as young as four years old, the results are impeccable. The Netherlands has one of the lowest teenage pregnancies, abortion, and sexually transmitted diseases (STDs) rates in Europe.
A study by the All India Educational and Vocation Guidance Institute found that between 42% to 52% of young students in India feel that they do not have adequate knowledge about sex. In a recent survey conducted by India Today, a leading news magazine, in 11 Indian cities revealed that almost half of all young people interviewed didn’t know enough to protect themselves from HIV/AIDS.
Due to this, it is submitted that India is obliged to provide comprehensive sexuality education in all public and private schools in India and that the denial of such education to children, adolescents and young people generally and the banning of the Adolescence Education Programme (AEP) by state governments specifically is a violation of India’s commitments under international law. Arguments on culture, morality or federalism are invalid in this context. Further, the provision of age-appropriate comprehensive education on sexuality and HIV/AIDS can also have important consequences in dealing with child abuse and in reducing the spread of HIV/AIDS.
In many African countries CSE, gender sensitisation and human rights education are not supported due to lack of political will. The 2003 Maputo Protocol initiated by members of the African Union encourages member states to integrate gender sensitisation and human rights education at all levels of education; it has not been ratified by two-thirds of the African member states. Implementation of CSE is donor-driven with oversight given to both Education and Health Ministries, creating funding and accountability problems.
Without information on sexual and reproductive health and gender equality, young people face a heightened risk of contracting HIV or experiencing unintended pregnancy, which might not only limit their future prospects but also put their lives at risk. Complications during pregnancy and delivery are one of the leading causes of death among adolescents globally. Research has established that CSE can improve sexual and reproductive health knowledge, and be effective in reducing risky sexual behaviour. Studies in sub-Saharan Africa have to an extent affirmed these results, indicating that changes in adolescents' sexual behaviour after exposure to these programmes are modest, but achievable, while positive improvements in adolescents' attitudes and knowledge were consistently produced.
This story has been produced with the support of The Africa Women Journalism Project (AWJP)