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Promoting pill for minors the real menace, not long school holidays

As the longest vacation of the school calendar climaxed with Christmas last weekend, it has emerged that pregnancy could be the least risk for sexually active teens.

Recent weeks have seen an upsurge in the promotion of contraceptives for schoolchildren to ward off pregnancies, which are likely to result from overindulgence in sex. Expansion of adolescent-friendly services is regarded as the answer.

The 2015 National Adolescent Sexual and Reproductive Health Policy defines adolescent-friendly services as “Sexual and reproductive health services delivered in ways that are responsive to specific needs, vulnerabilities and desires of adolescents. These services should be offered in a non-judgmental way that fully respects human dignity.”

The policy places adolescents in the 10-19-year age bracket, which accounts for 24 per cent of Kenya’s population.

Inclusion of 19-year-olds in the 2015 document is problematic as regards policy interpretation. This is because while the law treats under-18s as minors, incapable of consenting to sex, over-18s are adults, who may do as they wish with their bodies. Sex with an under 18 is punishable under the laws of Kenya.

Making contraceptives readily available to minors is premised on the argument that the long holiday exposes learners to unwanted pregnancies.

In an interview with clinical psychologist Gladys Mwiti, she dismissed this argument as “defeatist”. She said “parents are shirking their responsibility”; they are delegating their responsibility to somebody else.

Gynaecologist Jean Kagia agreed that the holiday was long, but regarded it as a blessing. “Children are usually in school, busy with homework and hardly have time with their parents.” Parents can use the long holiday to teach, counsel, and understand their children,” she said.

Dr Kagia dismissed assumptions that sex is all that children do with their extra time: “We’re assuming that all children are immoral.” But most children have been under the guidance and teaching of parents or teachers. Others have been taught in churches, mosques, and by various religious groups “so there has been a tendency of children to be guided morally; we can’t assume that children do nothing except play sex,” she said.

YOUNG ADULTS

Dr Mwiti distinguished between children (up to 18), and young adults, who should be left “to make up their minds because you’ve laid for them a foundation”.

The reason many parents were jittery about their children’s safety and “would want to take a defeatist attitude and give them the pill” was that many of them had not laid the foundation for their children.

“When we don’t teach children the right things to do, then no wonder we want to pick a quick solution called the pill or contraceptives,” Dr Mwiti said.

Like Dr Kagia, the psychologist saw the long holiday not as a threat, but as an opportunity for parents and children to plan their time together.

Contraceptives, she said, do not only prevent pregnancy; their use by minors has far-reaching consequences, which she encounters in her day-to-day work.

“I’ve seen broken children in my clinic with crying parents,” she said, adding, contraceptives are not 100 per cent safe.

Condom failure, which an Internet search put at 12 per cent, can result in sexually-transmitted diseases, leading to infertility. Dr Kagia concurred, noting that adolescents had the highest contraceptive failure rates “because they are big defectors” of taking pills.

She explained that when women — and not just children — take pills, they tend to experience side-effects, such as breakthrough bleeding. This is vaginal bleeding, usually in the middle of menstrual cycles in users of combined oral contraceptives. The bleeding is attributed to insufficient oestrogens and may also occur with other hormonal contraceptives.

A girl on the pill, who bleeds mid-cycle, is unlikely to persevere as an adult would. She will discontinue taking the pill, putting herself at higher risk of pregnancy, the doctor cautioned.

Because adolescent-friendly programmes tend to exclude parents — despite the policy aspiration to include them in the conversation — such children usually present to hospitals for abortions accompanied by boyfriends, either because of pregnancy-related complications, or because they fear letting their parents to know.

The doctor has to find the parents to sign for consent, and if the parent in untraceable, to sign on the minor’s behalf.

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