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Young, Gifted and…Pregnant

The month of May is dedicated to preventing and ending teenage pregnancies worldwide. But as the month comes to an end, Kenya is still not close to achieving this goal.

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One in every five Kenyan girls aged between 15-19 has had a live birth or is pregnant. It’s a mind-blowing statistic that speaks to the teenage pregnancy crisis in the country – the United Nations Population Fund estimates that there were about 380,000 cases in 2019 alone. Eighteen-year-old Patricia* (not her real name) was referred to me for legal advice, as she had one such pregnancy. Orphaned at an early age, her paternal uncle took her in but sexually abused her for several years. Today Patricia is 5 months pregnant and not in school, even though this should have been her final year. And while her uncle should be charged under the Sexual Offences Act – facing not less than 15 years in prison if convicted – Patricia will not testify against him for fear of losing the only financial support she has.

The month of May is dedicated to preventing and ending teenage pregnancies worldwide. But as the month comes to an end, Kenya is still not close to achieving this goal. Patricia is one of thousands of girls in Kenya stuck in a predicament caused by sexual violence, lack of information on, and access to youth-friendly sexual and reproductive health. For these girls, their education will be interrupted and their social and economic choices taken away from them.

Teen Pregancy Infographic.png

But there are also increased health risks associated with teenage pregnancies, including physical health issues like convulsions, uterine infections and obstetric fistula – a hole in the birth canal, resulting in incontinence of urine or faeces that often affects women who give birth too young – and mental health challenges like depression and anxiety. And there are risks to the unborn child including premature birth, low birth weight and other neonatal conditions. Preventing teenage pregnancies is about protecting the holistic health of both the mother and the potential unborn child, and by extension, society as a whole.

The Kenya Demographic Health Survey 2014 reported a 2% drop in teenage pregnancies over a 20-year period. This was caused by major changes in girl’s education programmes and in the sexual and reproductive health and rights landscape in Kenya that made birth control and other services more accessible to teenage girls. Yet in 2014, the Kenyan Parliament shot down the Reproductive Health Care Bill sponsored by Senator Judith Sijeny, which suggested among other things, that adolescents be given unrestricted access to comprehensive sexual education and confidential sexual and reproductive health services. There was uproar around the bill, with Kenyans citing religious and cultural beliefs to reject it. But the facts betray this opposition: the same survey (KDHS) shows that about 11% of teenagers, nationwide are having sex before their 15th birthday. Kenya’s teenagers need better access to sexual and reproductive health services.

It’s not all doom and gloom though. In 2013, Kenya signed the Ministerial Commitment on Comprehensive Sexuality Education and Sexual and Reproductive Health Services for Adolescents and Young People in Eastern and Southern Africa. In 2015, the Ministry of Health enacted the National Adolescent Sexual and Reproductive Health Policy that aims to enhance the sexual and reproductive health status of adolescents in Kenya and contribute towards realization of their full potential in national development. Additionally, two months ago in March, Kenya through the National Council on Population Development (NCPD), launched the first-ever government-led multi-stakeholder campaign against teenage pregnancy dubbed ‘Let’s Act to End Teenage Pregnancy’.

But sex education is still not being uniformly delivered across the country. Teachers are not all adequately trained and can often pass misinformation onto the students. An African Population and Health Research Center (APHRC) study found that 1 in 4 secondary school students in Homa Bay, Mombasa and Nairobi counties thinks that using a condom during sexual activity is a sign of mistrust. The content of the curriculum is also heavily focused on content covering abstinence and sexually transmitted infections, ignoring other important topics like contraceptive use and access to safe abortion. Furthermore, a new Reproductive Health Care Bill (2019) threatens to negate the gains made on adolescent sexual and reproductive health and rights as it requires health providers to seek parental consent before providing adolescents with sexual and reproductive health services. Requiring parental consent is likely to result in an increase in unintended teenage pregnancy and unsafe abortions because teenagers may not want their parents to know about their sexual activities.

Ending teenage pregnancies will take a concerted effort of policy mixes. The judiciary must strictly implement the Sexual Offences Act. The legislature must review the issue of bride price, particularly, where teenage girls are concerned to de-incentives teenage marriages. Increased girls educational programs and opportunities created. Teachers must receive adequate training on comprehensive sexuality education. A wide range of sexual and reproductive health topics should be taught in the classroom but also parents and guardians must take the lead in providing their teenagers with correct and age appropriate information on sex. Lastly, the legislature must urgently amend Section 33(a) of the proposed reproductive health care law, to enable teenagers freely access quality, youth friendly sexual and reproductive health services. It’s time to bring down Kenya’s startling teenage pregnancy statistics.

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Stephanie Musho is a constitutional lawyer based in Nairobi, specializing in sexual and reproductive health rights, and an Aspen New Voices Fellow.

Data Stories

Will 10 Million Kenyans Get At Least One Dose of a COVID-19 Vaccine by Christmas Day?

Based on the MOH daily cumulative number of vaccines administered, Kenya is on course to have 10 million vaccines administered by Christmas, based on the predictive AutoRegressive Integrated Moving Average (ARIMA( 5,2,1)) model.

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Will 10 Million Kenyans Get At Least One Dose of a COVID-19 Vaccine by Christmas Day?
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During his eighth and last State of the Nation address on 30 November 2021, Uhuru Kenyatta reminded the nation of his pledge to have at least 10 million Kenyans vaccinated by Christmas. With just 25 days to go, the president urged Kenyans to get vaccinated to meet and surpass that target.

On the day of the president’s address, just 7,175,590 doses of the 13,909,670 received in the country had been administered.

The pressure to vaccinate Kenyans has been increasing. Data shared by the Ministry of Health in late November indicated that less than 10 per cent  of the targeted population was fully vaccinated and about 15 per cent had received at least one of the  COVID-19 vaccine doses.

Just nine days before the president encouraged Kenyans to get their COVID jabs, Cabinet Secretary for Health,  Mutahi Kagwe announced some tough measures. He said that Kenyans will be required to show proof of vaccination when boarding domestic flights, trains and buses, and while travelling from one region to another.

“Everybody seeking in-person government services should be fully vaccinated and proof of vaccination availed by December 21st 2021,” he said. “Such service will include but not limited to KRA services, education, immigration services, hospital and prison visitation, NTSA and Port services among others.”

The announcement sparked much debate among the public. Human rights defenders argued that the measures violated freedom of choice and threatened to deny basic services to citizens. Some taxpayers even joked about not paying their taxes since if they were unvaccinated, they would not be receiving government services.

Business owners, especially in the tourism sector, criticised the potential negative impact of these pronouncements on their businesses which experience a boom during the Christmas holidays.

But in the week following this announcement, the number of doses administered daily increased to over 100,000, except on the Saturday and Sunday. This is a significant rise. If we take data beginning on 28 September 2021, when MOH began to consistently upload the status reports, the average number of vaccines administered on a daily basis since that date was 52,796.

Vaccine roll out

The vaccination process has been highly dependent on the availability of vaccines, with more than half being  donations from higher-income countries like the US, UK, Denmark, Poland, France, etc.

Where the dates have been disclosed, the duration to expiry of the donated batches was between 25 and 136 days. While the Johnson & Johnson  batch that the government of Kenya had received on 3 September 2021, just before it last reported the expiry date of various vaccine batches, had 635 days to expiry.

It is not reported whether there were any vaccines that were discarded because they had expired.

Kenya had received 13,909,670 vaccines by 30 November 2021. The challenge is to match uptake with the now increased availability of vaccines. More than half of these vaccines are yet to be administered.

So, how likely is it that the government will have every adult Kenyan vaccinated by 21 December 2021 to avoid the consequences announced by CS Kagwe? Or is President Kenyatta’s Christmas pledge more realistic?

Predictions

Based on the MOH daily cumulative number of vaccines administered, Kenya is on course to have 10 million vaccines administered by Christmas, based on the predictive AutoRegressive Integrated Moving Average (ARIMA) model.

But this forecast will become reality if more Kenyans are persuaded to take the time to visit their nearest medical facility which according to the President is now stocked with the vaccine doses.

More realistically, about 9 million doses could be administered by Christmas if all factors remain constant.

The cumulative number of vaccines administered is non-stationary, meaning that it has a time-dependent structure and does not have constant variance over time. This can be  attributed to pattern changes based on the availability of COVID-19 vaccine doses in the country and also due to various efforts undertaken by the ministry at different times.

It is clear, however, that the uptake of the doses has now become steady. But the uptake is not increasing at the same rate as the vaccines are becoming available. This could be because of ineffective communication to the public. Also, there may be vaccination apathy following the long waits for sufficient vaccines, the long queues once they become available and visits to medical facilities only to find no vaccine. I made one such visit which was disappointing.

Worthy of note is that in August the government issued its first vaccine mandate to all public servants who were compelled to get COVID jabs or face disciplinary action.

Now, over 95 per cent of health workers and teachers are fully vaccinated. The new mandate widened the scope to the general population, including millions of jobless Kenyans, and seems to be bearing fruit already.

Data management challenges

The prediction above is based on the kind of data the ministry of health has released. The MOH Twitter page and website have been the main avenues through which vaccination progress has been communicated.

Looking at the vaccination data, one gets a sense of how the data aspect of this pandemic has been a case of “building a plane while you fly it”. This can be seen in the way data is released for public use.

Data is first shared in the form of images on twitter and PDF documents are then uploaded on the MOH website.

Let us drill down to illustrate some problems by focusing on 14 July 2021.

  • The vaccines that had been administered on this day were 1,565,344.
  • The same status report indicates that 31 first dose and 1034 second dose were administered on that same day.
  • Total vaccinations on 15 July 2021 were 1,590,765. It is not clear why the difference between the two days is 25,421, since the doses reported to have been administered on the 15th are 263 for the first dose and 6730 for the second dose.
  • The discrepancy is not comprehensible and it is the case for many other days until much later, in November, when the numbers start to add up.

Additionally, the number of total daily vaccinations in the status reports uploaded on the MOH website differs with what is in the Humanitarian Data Exchange (HDX), HUMDATA, an open platform for sharing data across organisations which relies on figures that are verifiable based on official public sources including Our World in Data (OWID) who in turn extract data from the updates from the MOH twitter timeline as well as on the website.

Another major issue for anyone seeking to explore Kenya’s vaccination data is missing data.

Dataset such as HUMDATA and OWID had data scraped from the MOH twitter updates initially.   We had to  combine data from the HUMDATA dataset and MOH status reports together to reduce the amount of missing data. However some figures recorded by Humdata were a day ahead compared to the figures in the available status reports presented on the MOH website.

The level of readiness in terms of how to capture and manage  the data is questionable. The status reports shared had not captured or anticipated the assortment and diversity of the vaccines Kenya would receive over time. Several elements (variables) are introduced at different times. This makes any automated technique of extracting the data extremely difficult and time-consuming. For example, up until 1 July, the reports had “Cumulative persons vaccinated to date”. But this was changed  to “Total vaccinations” to cater for those who were receiving their second doses of the AstraZeneca vaccination which began on 28 May 2021. Later it emerged that just a single dose of Johnson & Johnson would amount to full vaccination status so official data was changed from Dose 1 and Dose 2 to partially and fully vaccinated persons.

Gender was another variable that evolved with time. Initially genders were badged male, female and “other”. This was later changed to “intersex”, and “transgender” was subsequently added.

These discrepancies, in addition to the data provided in PDF forms, make it extremely difficult and time consuming for experts to explore the data and for the public to monitor the accountability and transparency of the vaccine uptake.

This OUTBREAK story was supported by Code for Africa’s WanaData program as part of the Data4COVID19 Africa Challenge hosted by l’Agence française de développement (AFD), Expertise France, and The GovLab

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Secondary Education: Kenya Needs to Think Beyond 100% Transition

COVID-19 has shown that there is a need for revolutionary thinking within the education sector if all children are to get a chance of an education.

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Secondary Education: Kenya Needs to Think Beyond 100% Transition
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The Ministry of Education in Kenya has continued to push for 100 per cent transition of pupils who sit for the Kenya Certificate of Primary Education (KCPE) examinations in order to ensure that every child gets the full benefits of a secondary education.

Secondary school is the bridge between primary level education and tertiary education whose benefits go beyond attaining a formal education. For instance, secondary education contributes to the reduction of HIV infection among girls, as they are able to delay becoming sexually active and avoid early marriages. Access to a secondary school education also reduces poverty among girls and enhances their chances of employment. Secondary education also benefits the whole society as girls, and the youth in general, spend more time in school, and are therefore less likely to become involved in violence, either as perpetrators or as victims of crime.

Moreover, evidence shows that a secondary education leads to a decline in socio-economic inequality between girls and boys, with secondary education having the most effect on bridging the gap. Furthermore, evidence suggests that children of educated mothers are more likely to progress and complete school than those children whose mothers are not educated. Overall, a secondary education levels the field of opportunity for young people and increases their chances of earning higher incomes and thereby attaining a higher standard of living.

What is the status of enrolment in secondary school?

The status of enrollment in secondary school
Data from the Kenya National Bureau of Statistics shows that between 2016 to 2020 secondary school enrolment by class and sex grew by 8 per cent to about 3,520,000, out of which 50.3 per cent were girls. This increase was attributed to the government’s policy of ensuring 100 per cent transition from primary to secondary school. Looking at the 2020 school year, following the COVID-19 pandemic, Kenya’s total secondary school enrolment decreased from 3.5 million in March 2020 to 3.3 million in March 2021, a 5.7 per cent drop as schools reopened. Moreover, out of those enrolled in March 2020, approximately 233,300 students did not return to school to resume learning when schools reopened in March 2021, representing 6.6 per cent of the students enrolled in March 2020. The number of secondary schools that were able to reopen increased by 0.4 per cent.

A persistent problem

While between 2016 and 2020, there was an increase in the number of pupils transitioning to secondary school, the decrease in enrolment between March 2020 and March 2021 prompted the Ministry of Education to reach out to parents across the country in a bid to ensure that all children returned to school. The drive faced challenges including poverty, poor parental attitudes towards education and ad hoc policy implementation.

Evidence shows that a secondary education leads to a decline in socio-economic inequality between girls and boys.

But by far the most common and most significant challenge to the push for 100 per cent transition to secondary school has been poverty. Many parents say that a lack of resources hinders them from sending their children to secondary school, a challenge that has been exacerbated by the impact of COVID-19 on household incomes across the county. Parental attitudes where for one reason or another parents resist sending their children to school also pose a challenge. Calls for parents’ cooperation from the Cabinet Secretary for Education echo my reflections in a 2018 article where I observed that “bottom-up strategies” may be useful in creating the groundswell for the transition push. This would help avoid the implementation of haphazard policies such as sending government officials around the counties to “drive children back to school”. If parents work with both the national and county governments, they will create a sustained push to ensure that students not only make a transition to the first year of secondary school but that they also stay in school.

Why we may need to reimagine education

Why we may need to re-imagine education
In addition to stimulating an attitude shift in parents, particularly towards their children’s education, it is important that the Ministry of Education, in collaboration with Non-Governmental organizations, develop programmes that can empower the parents financially to keep their children in school. The Advanced Learning Outcomes project (ALOT Change), a community-based initiative by the African Population and Health Research Center (APHRC), has been instrumental in working with parents in Nairobi’s informal settlements so that they can better understand their own roles in the education of their children.

By far the most common and most significant challenge to the push for 100 per cent transition to secondary school has been poverty.

Education stakeholders in both the public and private sector need to work in close partnership to seek better ways of providing scholarships for those children who are in need of school fees support. Through A LOT Change, APHRC has provided subsidies to pupils transitioning to secondary school. The US$ 113 subsidy has been instrumental in decreasing the financial burden of parents, as they are able to purchase books, school uniforms, and other materials required for school. The lessons learned from such programmes can be adopted and scaled up by both the public and private sectors in order to provide relief to parents facing financial challenges.

Some of the students who were “driven back” to the first year of secondary school had to go to school in their primary school uniform. Might it also be time for the education system in Kenya to reconsider the issue of school uniforms? This could also contribute in a small way to reducing the financial burden for parents. Moreover, COVID-19 has shown that there is a need for revolutionary thinking within the education sector if all children are to get a chance an education. The government therefore needs to ensure that schools are better able to take advantage of emerging technologies such as EdTech by, for instance, improving school infrastructure (including computer labs) and access to electricity. This would enable schools to provide both virtual and in-classroom teaching and thus ensure that students get the best of blended learning, linking the finest tenets of in-person and virtual learning.

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Deedha: How Pastoralists Communities Are Effectively Managing Drought and Conflict

With climate trend likely to worsen, it is crucial now for development partners, Civil Society Organizations (CSOs), and policymakers to rethink climate change adaptation and management in light of pastoralist’s indigenous knowledge and traditional resource governance structure such as Deedha to protect pastoralism which has continued to provide a lifeline to millions of households in the horn of Africa.

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Deedha: How Pastoralists Communities Are Effectively Managing Drought and Conflict
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The first known drought in Northern Kenya was about 120 years ago (Wajir 1901, Mandera and Garissa 1902, Tana River 1905, and Isiolo 1927). Since then, 30 major droughts have been recorded in Northern Kenya. While a slow-onset disaster, drought occurrence has reduced to an interval of every 1-2 years in the last two decades.

Despite Africa’s minimal role in global warming, climate risks in Africa are growing bigger and continue to impact negatively rural agriculture and the pastoral economy.

In northern Kenya, drought often results in loss of lives and livelihoods, forcing thousands of households to drop out of pastoralism. Additionally, the Lack of rains undermines the growth of pasture and water availability for both humans and livestock. And as scarcity sets in, the use, control, and access to pasture and water are contested, often leading to risks of violent conflict.

Drought uncertainty triggers an old age survival strategy; – mobility where pastoralists either move to escape drought, conflict, or both. This strategy is incorporated within a traditional resource governance mechanism called Deedha amongst the Borana pastoralists group living in southern Ethiopia and Northern Kenya counties of Isiolo and Marsabit.

Deedha: How Pastoralists Communities Are Effectively Managing Drought and Conflict
Practiced over a century, the system is elaborate; ‘it considers and plans how pasture and water resource’ is planned to last between seasons. Unique and structured, Deedha planning depends on the number of rains received and the pasture regenerated. So effective is the ‘system’ that the knowledge has supported the rearing of cattle to date despite high vulnerability and weak resilience traits.

For a long time in Kenya, cattle keeping has remained synonymous with the Maasai people. Yet in Kenya’s north and southern Ethiopia, the Borana communities have kept cows for equally long periods, so valued attached is that they have family names.

Various groups, including men, women, and young men, have also composed songs praising the cow’s beauty, walking style, milk yields, and how the herd owner moves around with them in the best of rangelands with constant surveillance against the raiders.

So emotive is any cattle disposal plan that a family meeting must be called, where reasons are evaluated to ascertain whether the sale is justified or not.

Another anecdote is also told of how various species respond to different needs, particularly water where camel would stay for a more extended period, followed by goats and sheep and cow in that order. At the same time, this story avers different resilience traits; the Boran has refused to divorce themselves from cattle keeping despite scaled up advocacy on the need for livelihood diversification in the wake of climate change and conflict risks.

Promotes Sustainable use of rangelands

Founded on the principle of sustainable use of the rangelands, the Deedha system is reciprocal. It encourages sharing resources and providing a safe drought haven for other pastoralist groups from other fragile counties such as Wajir, Garissa, Marsabit, Samburu, and even Laikipia.

The system is designed to encourage mobility over large tracts of land, helping the pastoralists break the pest cycle, aerate the soil (breakdown of soil with hooves), and manage unwanted vegetation.

The institution of Deedha is headed primarily by an elder, with each area having its Deedh (traditional grazing area to a particular group), which is linked to other deedha’s.

Informal but highly effective, the Deedha employs critical rangeland management, where the systems consider rangeland planning based on ecological vulnerabilities, livestock populations, an anticipated influx in determining when and where livestock moves, and whether there is a need for activation of the strategic boreholes.

The system partitions the rangeland into three grazing parts as dry, wet, and drought grazing areas, with also flash floods along the Ewaso Ngiro River considered as a season and blessing due to pasture regeneration in the swampy areas. In managing and protecting the rangelands, the Deedha traditional systems discourage sedentarization in strategic rangeland as part of conservation strategy after the use and boreholes areas, where Genset/pumps are mobilized during drought crises and demobilized on the fall of rain.

Manage drought and conflict

The system also incorporates the young people into Deedha resource planning and use and this is for two reasons; undertake pasture and security surveillance (Aburu and shalfa) in the far-flung Deedha’s which borders known or perceived enemy territory.

The system is so unique that critical access planning is done based on anticipated risks and livestock (species) vulnerabilities where Hawich (Milking herd) and non-milking herds (Guess) are split as defined by production and physical traits, respectively.

Hawich (Milking herds) are lactating, and some old and weak female breeds while non-Milking (Gues) are young female and male breeds with the ability to trek long distances searching for pasture and water. The system also calls for the protection of migratory and watering routes. While water for all livestock species is a priority, this customary system prioritized water for livestock in transit and the donkey over other livestock species for its role in household management. The system’s effectiveness has also seen it advocates for the protection of watershed areas and ensuring the cleanliness of the water point environs after all the livestock has been watered.

Deedha: How Pastoralists Communities Are Effectively Managing Drought and Conflict
The Deedha also has in place resource sharing plans internally and externally, where Deedha in one location consult another Deedha before any decision is made. Such arrangement is also captured and advocated for by more recent attempts in enhancing resource sharing and ending conflict through such declaration as the Modogashe-Garissa, first entered in 2001 which calls for strengthening of resource governance and sharing framework between communities during drought. Thus, Deedha proactively enhances resilience through resource sharing and a framework for negotiations between communities during drought.

While Isiolo also had its fair share of drought, the use of this highly effective system has cushioned pastoralist group in Isiolo against the drought, only making foray into other communities’ rangeland in 1992 when Isiolo livestock moved to then Moyale District, Kauro in Samburu in 2000 and 2017 again to Moyale. The migration in 2017 was necessitated by fear following conflict escalation between the Borana and Samburu, leading to loss of 7 lives and over 3000 head of cattle in what the local Borana communities cite as security imbalances created by the Northern Rangeland Trust (NRT) to instil fear and force local pastoralists communities to abandon key strategic drought reserve in Chari Rangelands in favour of wildlife conservancies.

Untold, Deedha also calls for the protection of endangered tree species such as AcaciaAnthath and Qalqalch in which users are not allowed to overexploit, with individuals found out on the wrong punished. Equally, the system put communities at the Centre of wildlife conservation as it discourages reckless killing either for food or even trophies. The system also advocates for leaving water in the trough for wildlife to access in areas where the only water sources are deep wells.

Deedha is an example of bottom-up ‘law or rules’ for rangeland management; it addresses environmental and wildlife conservation. Like in predictive climate science, Deedha elders consider planning on how the previous seasons have performed. Further, the elders can predict trends and rain behaviour patterns based on Uchu, who closely work with the institution of elders.

With climate trend likely to worsen, it is crucial now for development partners, Civil Society Organizations (CSOs), and policymakers to rethink climate change adaptation and management in light of pastoralist’s indigenous knowledge and traditional resource governance structure such as Deedha to protect pastoralism which has continued to provide a lifeline to millions of households in the horn of Africa.

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