When Margaret sought family planning, she relied on a friend's advice about an injectable contraceptive she understood would protect her from pregnancy for five years.
Later, after becoming seriously ill and being diagnosed with hepatitis B, she began to question whether the method had contributed to her condition.
At the time of the interview, Margaret said she was around six to seven months pregnant. As an adolescent, she left home and lived on the streets. When she became pregnant, she hid the pregnancy before eventually giving birth at Pumwani Maternity Hospital.
A second pregnancy followed. With little information about family planning, she relied on a friend's recommendation of the injectable contraceptive.
Later, Margaret developed heavy bleeding, lost weight and became seriously ill. After seeking medical attention, she was referred to Kenyatta National Hospital, where she was diagnosed with hepatitis B. Suspecting a connection between the injection and her illness, she had the contraceptive removed.
She continued attending a liver clinic at the hospital. After her mother's death, she resumed contraception but forgot her dates and became pregnant. She later miscarried and suspected family planning had contributed to her illness, prompting her to stop using it.
Margaret later tried herbal remedies and emergency contraception, commonly known as P2. After going about a year without becoming pregnant, she believed she could no longer conceive but got pregnant again.
Her experiences reflect the difficulty of making reproductive healthcare decisions when information is limited and concerns about treatment remain unresolved.
For adolescents and young people in Kenya, accessing reproductive healthcare can involve fear of judgement, anxiety about parents finding out, uncertainty about confidentiality and concern about possible legal consequences.
For Molin, a 21-year-old young mother from Soweto in Kibra, finding information about family planning began online. She searched Google before a community mobiliser working with Tiko connected her to a doctor.
Molin uses family planning because she wants to avoid another pregnancy while completing her studies. Although her mother encouraged her, she has not told her friends that she uses contraception.
She says misconceptions about contraception, including claims that it causes weight gain or weight loss, influence how people around her view family planning. She also worries about being judged.
Jane, 20, a young mother from Gatwekera in Kibra, also wants to avoid another pregnancy. Parenting alone has been difficult, and she does not want another child at this stage of her life.
Before seeking family planning, she feared that her friends would mock her and that her mother would become angry. A community mobiliser explained the available options and accompanied her to a hospital, where she says the doctor treated her well.
CONFIDENTIAL WORRIES
Both women's experiences highlight the importance of accessible information, community support and healthcare workers who treat young people without making them feel ashamed.
These personal realities align closely with findings from the 2022 Kenya Demographic and Health Survey Summary Report, which indicates that 15 per cent of adolescent women aged 15–19 in Kenya have ever been pregnant.
Twelve per cent have given birth, 1 per cent have had a pregnancy loss, and 3 per cent are pregnant with their first child.
The data further demonstrates clear socioeconomic divides, with adolescent pregnancy standing at 21 per cent among those in the poorest wealth quintile, compared to 7 per cent in the richest quintile.
Everlyne Bowa, founder and executive director of Awoche Foundation, says adolescents and young people face multiple barriers when seeking reproductive healthcare. These include inadequate information, stigma, judgement of sexually active young people and concerns that parents or others may discover they have sought services.
For those living in informal settlements, Bowa says, confidentiality is a particular concern. Young people may worry that information about their consultations will circulate within their communities or reach their families.
Data detailed in the 2022 KDHS Main Report Volume 1 highlights this disparity in modern contraceptive use across age cohorts: only 14.8 per cent of sexually active unmarried adolescents aged 15–19 use modern contraceptives, compared to 45.2 per cent of sexually active unmarried young women aged 20–24.
Geographic disparities in adolescent pregnancy are similarly pronounced across counties, ranging from 50 per cent in Samburu to 5 per cent in Nyeri and Nyandarua.
Access is also affected by the cost of services, distance to health facilities and opening hours that do not accommodate young people's schedules.
Bowa advocates for youth-friendly services that protect privacy and treat adolescents and young people respectfully. She also calls for community mobilisation, mentorship and accurate reproductive health information in schools, churches and other community spaces.
She says young people should help shape programmes designed for them, rather than be treated only as recipients of information or services.
Nurse Eliakim Juma, who provides reproductive health services to adolescents and young people, says healthcare workers consider several factors when responding to a young patient's request. These include age, the reason for the visit, the clinical assessment and consent.
When a case is unclear, Juma says, he seeks guidance from senior colleagues.
Concerns about complaints, disciplinary action or possible legal consequences can make providers hesitant, he says. Some may refuse to provide a service or involve a parent because they are uncertain about what the law requires.
Juma adds that embarrassment and fear of judgement can discourage young people from disclosing their concerns or seeking care.
He says training, mentorship, clear standard operating procedures, reliable supplies and supportive supervision can help healthcare workers respond appropriately. Community education is also needed to address misconceptions and encourage young people to seek accurate information.
LEGAL CONCERNS
The challenges also intersect with questions about children's rights, parental involvement and the legal responsibilities of healthcare providers.
The impact of these challenges is underscored by the 2022 KDHS Main Report Volume 1, which reveals that less than 39 per cent of the total demand for family planning among sexually active unmarried adolescents aged 15–19 is satisfied by modern contraceptive methods.
Margaret Nyambura, programme officer for HIV, TB and key affected populations at Kelin, identifies parental or guardian consent as a significant barrier to adolescents' access to reproductive healthcare.
She says the Children Act provides for parental involvement in children's lives and care, while confidentiality obligations can become complicated when a healthcare worker believes a parent must be informed.
This can leave adolescents uncertain about whether they can access contraception independently, particularly when they fear a parent's reaction. Nyambura says healthcare providers may also be unclear about how different legal provisions apply in practice.
She points to the shortage of youth-friendly centres, limited information and the cost of accessing care. Kelin is challenging the consent barrier in court, she says, as part of efforts to address obstacles adolescents face when seeking healthcare.
Elsy Sainna, associate director of advocacy and external relations for Africa at the Centre for Reproductive Rights, says Kenya's legal and policy framework contains protections relevant to health, privacy, equality and dignity.
She points to Article 43 of the Constitution, which provides for the right to the highest attainable standard of health, including reproductive healthcare; Article 53 on children's rights; Article 31 on privacy; Article 27 on equality and freedom from discrimination; and Article 28 on human dignity.
The Children Act 2022 and the Health Act 2017 are also relevant to children's welfare, healthcare and the responsibilities of service providers, she says.
However, Sainna argues that these protections must be understood alongside laws and policies governing consent, sexual activity involving people under 18 and the circumstances in which confidentiality may be limited.
Kenya's age of sexual consent is 18 under the Sexual Offences Act. Sainna also points to a ruling in Petition 490, which held certain provisions unconstitutional as applied to consensual, non-coercive and non-exploitative sexual activity between adolescents close in age. The ruling did not lower the age of sexual consent.
She says unclear or inconsistently implemented guidance can leave healthcare workers uncertain about when to provide services, involve parents or limit confidentiality. Providers may also have to consider safeguarding and reporting obligations where cases involve coercion, abuse or exploitation.
Sainna calls for clearer guidance for healthcare workers, confidential and youth-friendly services, comprehensive sexuality education and meaningful participation by adolescents and young people in decisions affecting their health.
For the young women seeking care, these legal questions affect whether they feel safe asking for help, trust the person providing it and can make decisions about their reproductive health without humiliation.
Monica Pollet's experience offers a contrasting perspective. She sought family planning at a private hospital, where she consulted a doctor and chose a method intended to last five years. She says the doctor and nurse explained the process and treated her well. Her mother accompanied her.
Her experience shows how supportive communication and the presence of someone a young person trusts can make seeking care less intimidating. However, not every young person has that support or feels able to involve a parent.
Bowa says families, schools, community organisations and healthcare providers should work together to make reproductive health information accessible and non-judgemental. She also advocates for adolescent-led initiatives that help young people identify barriers and shape services to meet their needs.
Juma's recommendations on training and supportive supervision, alongside Nyambura's and Sainna's calls to address legal uncertainty, highlight the need for clearer guidance and services that respect young people's rights.
For Margaret, difficult experiences with pregnancy, illness and contraception continue to shape her decisions. For Molin and Jane, community mobilisers helped them reach services despite their fears of judgement.
Their experiences show that making reproductive healthcare available is not enough. Adolescents and young people also need reliable information, affordable services, respectful treatment and confidence that their privacy will be handled appropriately.
