A new poll finds that 60% of US voters want President Joe Biden to endorse the motion by more than 100 lower- and middle-income countries to temporarily waive patent protections on Covid-19 vaccines at the World Trade Organization. Only 28% disagreed.
The survey, carried out by Data for Progress and the Progressive International, shows a super majority of 72% registered Democrats want Biden to temporarily waive patent barriers to speed vaccine roll out and reduce costs for developing nations. Even registered Republicans support the action by margin of 50% in favor to 36% opposed.
The new polling shows that “there is a popular mandate from the US American people to put human life and economic recovery ahead of corporate profits and a broken intellectual property system,” said David Adler, the general coordinator of the Progressive International. Burcu Kilic, research director of the access to medicines program at Public Citizen and member of Progressive International’s Council, called on Biden to “listen to Americans who put him in power” and “do the right thing.”
Due to WTO intellectual property rules, countries are barred from producing the current leading approved vaccines, including US-produced Moderna, Pfizer and Johnson & Johnson. In October of 2020, South Africa and India presented the WTO with a proposal to temporarily waive these rules for the duration of the pandemic so that vaccines can be manufactured across different countries, increasing their availability, reducing their cost and ensuring that they are delivered to everyone on earth as quickly as possible.
In the absence of the waiver, the current manufacturing and distribution rates are unlikely to stem the pandemic’s momentum, especially as new variants, which are more infectious and seem to evade the acquired immunity from prior infection or from the current vaccines, continue to emerge. The US under President Trump joined other richer nations to block them.
The shock poll reveals a level of public support for intellectual property waivers that will likely add to growing congressional pressure on Biden to join those pushing to save lives through a global vaccination drive. Congresswoman Jan Schakowsky is working on a letter to the president to which Schakowsky says more than 60 lawmakers have added their signature, including House Speaker Nancy Pelosi.
Senator Bernie Sanders, Chair of the Senate Budget Committee, responded to the poll saying the US should be “leading the global effort to end the coronavirus pandemic.” According to Sanders, “a temporary WTO waiver, which would enable the transfer of vaccine technologies to poorer countries, is a good way to do that.”
Responding to the new poll, Representative Ilhan Omar called on Biden to “support a waiver to boost the production of vaccines, treatment and tests worldwide,” arguing that it was “not just an issue of basic morality, but of public health.”
Adler argues, “US Americans know rigged rules to prop up big pharma’s profits are not in their interest. The longer the virus has to spread, the more it can mutate and become vaccine-resistant. Covid-19 anywhere is a threat to public health and economic wellbeing everywhere. If intellectual property restrictions are not lifted, the pandemic will go on for longer, killing more people and damaging more livelihoods.”
The threat to the Global South from vaccine apartheid is a “death sentence for millions around the world—and it is because giant pharmaceutical corporations would rather maximize profit than provide vaccines to people who need it,” according to Omar.
Sanders agrees, saying “the bottom line is, the faster we help vaccinate the global population, the safer we will all be. That should be our number one priority, not maximizing the profits of pharmaceutical companies and their shareholders.”
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State of Hunger: Unravelling Kenya’s Food Crisis
With 8.9 million Kenyans (17 per cent of the population) living in extreme poverty – below 1.9 USD (Ksh 250) a day –and a hunger level score of 23.5 which is way above the recommended 9 or less, many Kenyans are going hungry because they can’t afford to it.
As of 30th June 670 million people experienced insufficient food consumption globally according to the World Food Programme’s Hunger Map.
Moreover, the findings from the 2023 Global Report on Food Crisis suggest that achieving the goal of ending hunger by 2030 is ever more challenging because the number of people facing high levels of acute food insecurity has increased for the fourth consecutive year. In 2022, nearly 258 million people in 58 countries or territories experienced a food crisis or worse acute food insecurity. Even though there has been an increase in the population analysed, this was the highest on record since the Global Report on Food Crisis (GRFC) began reporting these data in 2017.
This global food crisis is driven by three key factors – conflict, economic shocks and weather extremes – linked to the enduring socioeconomic impacts of Covid-19, the war in Ukraine and repeated droughts.
In Kenya as of 29th June a total population of 14.1 million experienced insufficient food consumption which is a 4.3 million increase from the previous month, according to the Hunger Map.
Although the country produces enough food to feed the population, economic access remains a challenge. Kenya’s rate of self-sufficiency in the production and availability of food is 90.3 per cent against an import dependency of 12.7 per cent, but on the four indicators of the Global Food Security Index in 2022, Kenya scored 41.3 per cent on affordability, the only indicator where the country scored below average.
With 8.9 million Kenyans (17 per cent of the population) living in extreme poverty – below 1.9 USD (Ksh 250) a day –and a hunger level score of 23.5 which is way above the recommended 9 or less, many Kenyans are going hungry because they can’t afford to it.
Frida Mmbone, a casual labourer at a tea farm in Kakamega, said that she earns Ksh250 per day, working six days a week. Her husband is also a tea picker at the same farm, earning a similar wage. Their combined income of Ksh500 can barely meet their needs and those of their four children, given that they spend Ksh425 on food alone. With 85 per cent of their income going to food, they barely have enough to meet other basic expenses like their children’s education, healthcare bills and clothing.
“We have a small piece of land, but it doesn’t produce enough maize to last us till the next harvest, so we have to buy 2kg of maize flour every day. We also buy half a litre of milk, a quarter kilo of sugar, a Ksh20 portion of cooking fat and paraffin worth Ksh30 every day.
“With the constant increase in the prices of basic commodities, we have been forced to do away with some things. Now we only make breakfast during weekends, and luckily three of the children are in high school so they have tea at 10 and lunch in school. My husband and I have tea at work and skip lunch to save on costs,” she said.
The current food crisis is a result of several factors, including drought following a sixth failed rain season. The increasing intensity and shorter cycles between droughts have affected crop yields for five consecutive seasons. Pastoralist communities have also lost substantial numbers of livestock due to malnutrition.
These combined factors have led to the inflation of food prices limiting access and consumption of food staples.
According to the Kenya National Bureau of Statistics (KNBS), maize production in the country declined by 12.8 per cent from 42.1 million bags in 2020 to 36.7 million bags in 2021 and 34.3 million bags in 2022. Similarly, the volume of marketed milk decreased from 801.9 million litres in 2021 to 754.3 million litres in 2022 largely due to drought that resulted in scarcity of fodder for livestock.
As a result of decreased production due to drought, Kenya’s maize imports in the first nine months of 2022 more than doubled to 519,611.30 tonnes (5.7 million 90-kilogramme bags), from 214,100.9 tonnes (2,378,899 90-kilogramme bags) during a similar period in 2021. This is the highest maize import since 2017. The shortage of the staple left 5.1 million people in need of relief food and pushed up retail prices of maize flour.
Similarly, Kenya imported rice worth $275 million, becoming the 32nd largest importer of the cereal in the world, and making it the 12th most imported product in Kenya.
In addition to the effects of drought on food security, the war in Ukraine has disrupted global food markets, leading to higher prices for wheat, maize, and other commodities. Kenya is a major importer of these commodities, so the war has had a significant impact on the country’s food prices.
The war has also contributed to higher costs of production by disrupting the supply chains of fertilisers which resulted in shortages, increasing demand and purchasing costs. In 2020 Russia accounted for 17 per cent of fertiliser exports to Kenya.
Given that food, followed by energy, is one of the key drivers of inflation in Kenya’s consumer price index, these factors have put pressure on food supplies, putting overall inflation at 8 per cent in May, and food inflation at 10.2 per cent, in the same month. Rising prices have reduced the purchasing power of consumers, who now have to spend twice as much as before on most food staples.
Available income to buy basic needs like food is also under pressure from policy adjustments driven by pressure from the International Monetary Fund, which has seen the government increase taxes on everything including cooking gas (with a new VAT of 16 per cent from the previous 8 per cent). These adjustments were passed in the Finance Act 2023, touted to be the way out of the country’s debt crisis and into self-reliance. The law has since been challenged in court and its implementation suspended pending the hearing of the case.
Kenya’s economy is yet to recover from the effects of the Covid-19 pandemic, which affected the tourism sector that contributed up to 10 per cent of GDP before the pandemic. As of 2022, there was a notable increase in tourism revenue by up to 83 per cent but it is yet to reach pre-pandemic levels. The pandemic also created bottlenecks in the supply chain contributing to inflation.
Further, the drastic depreciation of the Kenya shilling against the dollar has made the importation of food and raw materials necessary for food production more expensive. The shilling’s value against the dollar depreciated by an average of 0.6 per cent monthly since March 2020, plunged to an average depreciation of 4 per cent per month in January and February 2023, then 6 per cent in March. The shilling has lost more than 25 per cent of its value against the dollar, exchanging at Sh140 to the dollar, and this has pushed up the prices of imported goods.
In the midst of the crisis Kenyans have nowhere to turn for relief. Among all 113 countries assessed for the Global Food Security Index in 2022, Kenya had an average score of 26.8 on food safety net programmes, which was less than the average of 72.4 for other countries. Moreover, the country scored zero on funding for food safety net programmes, yet it scored 100 on dependency on chronic food aid, against an average of 65.5 for other countries that were assessed.
With 56 per cent of the world’s population living in cities according to the World Bank, a new study reveals how crucial urban farming is to food security, given that the urban population is projected to grow to nearly 70 per cent by 2050. In Africa, the rate of urbanisation is 47 per cent, while in Kenya it increases by 3.7 per cent annually, with the rate of rural depopulation raising concerns about food supply given that there are fewer people living and working in farms.
Dr Antonina Mutoro, Associate Research Scientist at the African Population and Health Research Center, said interventions to address the hunger crisis by promoting urban farming should be sustainable and scalable, rather than temporary. This would mean considering systemic factors and government policies in addition to individual efforts.
“There is only so much we can do because our environment is influenced by what is going on in terms of politics and government policies. I am thinking of people living in informal settlements; they need structures put in place by the government to ensure there is space or innovative methods of producing food in small spaces in urban areas, access to safe water and capacity and knowledge to produce food safely. This will ensure that regardless of whether you have an income or not you have a sustained source of food.
“That being said, there is a limited amount of food one can produce for their own consumption and it also limiting when it comes to growing maize our staple food in those small urban spaces,” she explained.
Given that affordability is a major factor driving hunger in Kenya where there is a high rate of unemployment among the youth, Dr Mutoro said that this should also be addressed to ensure that people can access food sustainably.
“There is need for systems that ensure that people have access to money to buy food through the government creating income-generating activities and promoting farming as a source of livelihood, especially among the younger population by reducing costs of farm inputs and ensuring markets are profitable to farmers rather than causing them losses.
“This can contribute to a consistent food supply and reduce reliance on imports,” she noted.
She added that youth should be supported to adopt farming as a source of livelihood, saying that the average Kenyan farmer is 61 years old and that is likely to have implications on food production in 20 or less years.
Besides promoting food security through food production, innovative solutions are needed to prevent food wastage and ensure that surplus food reaches those in need. For instance, APHRC through its Zero Hunger Initiative champions ensuring that food that is produced is transported from places where it is in excess to areas where it is needed the most. By preventing food wastage, food security can be improved without requiring increased production.
Given that adverse climate conditions, particularly in arid and semi-arid areas contribute to food insecurity through failed rains and drought, long-term planning should consider climate change and invest in innovative irrigation systems and other climate adaptation strategies to maintain sustainable food production despite environmental challenges. Learning from countries like Israel, which effectively produce food in desert conditions, can provide valuable insights.
Subsidies and trade-offs which have been contentious issues, also have the potential to alleviate the crisis while still making farming profitable and ensuring farmers receive fair compensation for their produce. However, the trade-offs and potential impacts on the industry and market dynamics should be carefully considered before implementing such policies. Comprehensive discussions involving all stakeholders are necessary to reach agreements that balance the interests of different parties, and long-term planning should be prioritised over the short-term focus of political agendas.
“It is essential to establish structures and frameworks that transcend individual governments. Long-term planning and consistent implementation of initiatives are crucial for sustainable solutions to address food insecurity in Kenya and other African countries. Shifting agendas with political changes limit the effectiveness and continuity of proposed interventions,” said Dr Mutoro.
The right to adequate food is realised when every man, woman and child, alone or in a community, has physical, social and economic access to adequate food or means for its procurement. It is the state’s obligation to not only respect but protect and facilitate the realisation of this right by ensuring during times of crisis like now there are social safety nets that aim to ensure a minimum amount of food consumption and protect households against shocks to food consumption. These safety nets should be integrated as part of a larger policy of sustainable economic development so they are not viewed as charity but as developmental and as a way of building resilience to shocks.
This articlewas produced as part of the Aftershocks Data Fellowship (22-23)with support from the Africa Women’s Journalism Project (AWJP) in partnership with The ONE Campaign and the International Center for Journalists (ICFJ).
Sex Education: Are We Doing Enough?
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)
Declining Birth Rates No Cause for Alarm
The declining fertility and birth rate could yield a dividend for Kenya, particularly if investments are made in the education and skills of the working-age population.
After decades of efforts to reduce the fertility rate, Kenyan women are having fewer children, from eight children per woman in the 1970s to three in 2022.
According to Yohannes Dibaba Wadoa, a research scientist at APHRC specialised in sexual and reproductive health rights, the decline in fertility and birth rates is driven by socio-economic changes such as changing marriage and family formation patterns, increased use of contraception and access to healthcare, improved child survival, and women’s education and their increased involvement in modern society. Improved income and employment opportunities for both women and men have also led to the desire for fewer children.
“Women’s role has changed. They are perceived as equal to men and engage in productive employment rather than being segregated into childbearing and rearing roles,” said Wadoa, adding that improved healthcare and desire for fewer children lead to increased use of contraceptives. For instance, the percentage of married women who use contraceptives in Kenya increased from 33 per cent in 1993 to 63 per cent in 2022, according to data from the Demographic and Health Surveys.
Financial concerns could also be a factor, going by the concerns raised by respondents to an informal survey by the Africa Women Journalism Project (AWJP) shared on social media platforms. Many of the 39 respondents said they had delayed childbearing or restricted the number of children they had due to financial instability.
One respondent aged between 20 and 24 years said she wanted to have four children in future after working on financial stability to provide a happy life for her children. Yet another (in the 25-29 years age group) said she wanted to have two children and was laying an economic foundation for their future.
“I’m a student. Having a child at this point in my life will make me vulnerable and expose me to financial constraints,” she said, adding that society restricts what she should be doing at a certain age.
One man in his thirties (30-34 years) also cited financial stability, saying that he planned to have four children if his fortunes changed and if he could provide a better future for them; coming from a poor family, he had worked hard in school to break the cycle of poverty, but unemployment stands in the way of creating a better life for himself and subsequently keeps him from starting a family.
“I have been unemployed for 10 years since I graduated, so starting a family is a challenge. I also come from a history of poverty. I worked so hard in school to live a better life, but it’s like I am in a vicious cycle of poverty.”
At 27.357 births per 1000 people, the current birth rate is a 1.2 per cent decline from 2022, a trend that has provoked conversations about what that means for the Kenyan population. Globally, the UNFPA’s State of the World Population Report 2023 revealed widespread “population anxieties” that have governments adopting policies to raise, lower or maintain fertility rates. In countries with lower fertility rates, there have been concerns about the ageing population and the anticipated consequences such as an additional strain on social security services, with fewer workers expected to fund the increasing pension and healthcare needs of a greying population.
He had worked hard in school to break the cycle of poverty, but unemployment stands in the way of creating a better life for himself and subsequently keeps him from starting a family.
Some of these sentiments were expressed by respondents of the AWJP’s informal survey, with 13 per cent of the respondents expressing worry or concern about Kenya’s declining birth rate. However, the majority – Nearly half (49 per cent) of the 39 respondents – expressed positive sentiment towards Kenya’s declining birth rates, while a third (28 per cent) said it doesn’t matter. Most of the respondents (27) were female and 44 per cent were happy with the decline, while 57 per cent of the seven men who responded were content with the declining birth rates.
Most of the respondents who expressed positive sentiment about the declining birth rate were in the 25-29 years age group and had never been married, while those aged 35 years and above expressed concern about the declining birth rate, citing economic concerns, career, breakdown of values and change in priorities.
While most of the respondents did not have children, many of those who did had one or two and a good number said they did not plan to have more.
Since adopting its first family planning policy in 1967, Kenya’s goal has been to increase the use of contraceptives and reduce the fertility rate, which according to the latest National Family Planning Guidelines for Service Providers (6th edition) plays a key role in the achievement of national and international goals such as the Sustainable Development Goals (SDGs). A lower population through women having fewer children is expected to lead to development by reaping from the demographic dividend – having more people of working age to enhance productivity and drive economic growth.
Subsequently, the updated guidelines published in 2019 recommended more investments to accelerate rapid fertility decline. However, the current government reduced the allocation towards procurement of family planning and reproductive health commodities from KSh1.2 billion (2022-2023 financial year) to KSh1 billion for the 2023-2024 financial year, a deficit of 200 million.
Since adopting its first family planning policy in 1967, Kenya’s goal has been to increase the use of contraceptives and reduce the fertility rate.
Even as investments that would lead to a decline in fertility and yield a demographic dividend reduce, the guidelines note that “the demographic dividend is not automatic or guaranteed – it is earned through economic reforms that create jobs, investments in human capital and efficient governance”.
The declining fertility and birth rate could yield a dividend for Kenya, says Wadoa. “Birth rate is one of the key drivers for population growth or decline along with mortality (death) and migration. A falling birth rate brings about a decline in the rate at which the population changes from time to time. In Kenya, the rate of population growth declined from about 3.5 per cent in 1980 to about two per cent in 2020 due to declines in the birth rate. During the same time, the average number of children per woman declined from 7 children to 3.4 children. This has various implications for women, children, families and societies at large,” he says.
For one, fewer and well-spaced pregnancies are beneficial for the health and survival of the mother and the newborn. The converse is true: With too many births, closely spaced births and births at an older age, women may lack the strength and health to withstand the complications of pregnancy.
Secondly, as observed in national policies, a falling fertility rate means a lesser child dependency burden at the household and societal level, which reduces expenses on food, education and health services. Fewer children mean families can spend more on food and invest more in education and health services instead of struggling to meet the needs of many children.
A falling birth rate benefits a country’s development, particularly if investments are made in the education and skills of the working-age population (labour force). This demographic dividend will be larger the faster the birth rate falls.
“For women, a declining birth rate offers them the opportunity to engage in economic and social activities instead of spending their most productive years on childbearing and rearing,” Wadoa said.
A falling birth rate benefits a country’s development, particularly if investments are made in the education and skills of the working-age population.
Wadoa, however, warned of a relentless lowering of the birth rate which he said might create momentum for future population decline. He explained that a low birth rate reduces the population, not at all ages, but among the young, which leads to a smaller workforce and an older population and this has negative implications for economic productivity and per capita income growth.
Falling fertility rates could also lead to population declines in the long term (such as those in European countries), population ageing and a shortage of labour. Nevertheless, countries like Kenya will not experience such demographic challenges in the near future, even though the decline in fertility rates in Africa and in other low- and middle-income countries of the world is the result of years of population policies and programmes that focused on reducing fertility rates.
Kenya, for instance, launched a family planning programme in 1967 to reduce the fertility rate, which stood at eight children per woman in the 1970s. Over the years, the fertility rate has fallen to the current 3.4 in 2022.
For several years, especially before the International Conference on Population and Development (ICPD) that was held in Cairo in 1994, the discussion around population growth centred on the implications of rapid population growth for socio-economic development and environmental sustainability.
It was believed that rapid population growth in Low and Middle-Income Countries (LMICs) contributes to poverty, environmental degradation and conflicts, while the slow population growth in the developed world is leading to a shortage of labour force, population ageing, and social crisis in the long term.
Several Low and Middle-income countries (LMICs) have employed various strategies including educational campaigns, increased availability and affordability of contraceptives, improvements in healthcare infrastructure, and empowering women to make informed decisions about their reproductive health and use modern methods of contraception to bring down fertility rates and reduce population growth.
Policies adopted to manage population growth differ from country to country. For example, while Kenya adopted policies that promoted family planning programmes and created awareness of the various methods available, China adopted a one-child policy in 1979 which restricted couples from having more than one child. This was enforced by a variety of methods, including financial incentives for compliance, promotion of contraceptives, and while not endorsed by the government, compulsory sterilisations and forced abortions were part of the policy.
China’s one-child policy remained in place until January 2016 when it was amended to allow couples to have two children. But even after the policy was amended, couples still hesitate to have a second child for reasons such as concerns about their ability to afford another child, availability of childcare, and worries about how having another child would affect their careers, especially for mothers. Furthermore, decades of messaging and policies devoted to limiting family size to just one child succeeded in ingraining the viewpoint that having one child was preferable.
With the ICPD, the debate shifted from a demographic target (of reducing the fertility rate to 2.6 children per woman by 2030) to ensuring the upholding of people’s reproductive rights. This is the message Wadoa says should take centre stage, and something the UNFPA’s recent report titled Billion Lives, Infinite Possibilities: The Case for Rights and Choices, highlighted, noting that efforts to influence fertility rates can erode women’s rights.
Decades of messaging and policies devoted to limiting family size to just one child succeeded in ingraining the viewpoint that having one child was preferable.
This is often evident in discussions about declining fertility and birth rates, which often incorporate anti-feminist, nationalistic and misogynistic views, with women being viewed as baby-making machines. Their choice on whether to have or when to have children is often criticised as them abandoning the primary role of their existence.
According to Wadoa, the focus of population programmes should be ensuring the reproductive health and the rights of women, girls and men by providing access to sexual and reproductive health information and services. This recognises that people have the right to give birth to the number of children they want, when they want.
Moreover, the ICPD made it clear that women and couples have the fundamental right to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights. Thus, discussion about population growth should consider reproductive rights rather than demographic targets that aim to reduce or increase birth rates.
This article was produced as part of the Aftershocks Data Fellowship (22-23) with support from the Africa Women’s Journalism Project (AWJP) in partnership with The ONE Campaign and the International Center for Journalists (ICFJ).
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