Shame of abusing adolescent mothers during childbirth

By the time Emily * learnt that she was about to join an uncharted world of motherhood, she was a child. By every yardstick, she was young and naïve and only 14 and pregnant with her first baby. She kept the baby, hoping pregnancy would be blissful.

 A decade later, she describes the journey as having been a tough row to hoe.

Emily grew up in Korogocho slums in Nairobi and was raised by a single parent who died when she was still young.

While learning to live without a parent was already harsh, her pregnancy journey as a teenager was akin to being thrown in a float of crocodiles — scary and inexorable.

The judging society’s eyes, the mistreatment, the abuse in hospital, stigma – you name it.

“When my mother died, life became so unbearable that I could not afford necessities like sanitary towels. I started using sponges, which ended up irritating me with unbearable itches. I opted to do menial jobs to afford pads and the first person I approached was a male neighbour,” she tells Healthy Nation.

Her neighbour told her that he did not have any offers at the time, but he had another unconventional option — sex.

“I had never had sex. I thought about it and gave in just because I really needed a supply for sanitary towels. I didn’t know that my life was about to change,” she says.

After that encounter, little Emily didn’t know that she had been impregnated. It is until her sixth month that her sister noticed that she was not okay, and so she immediately took her to a clinic.

A few months later, her due date came and her sister took her to a hospital in Kiambu.

Despite being having piercing pain at the maternity ward, the doctors told her that she had about a month to get to her due date, but they asked her to stay in hospital for close monitoring.

“I was in pain for about three days and when it became unbearable, I crawled to the labour ward to get help from the doctors,” she tells Healthy Nation.

She was ignored, even when she cried out for help, she says.

“When someone is in labour, they feel like they want to poop. I got the same feeling and unfortunately messed up one of the beds. The doctor was so mad at me and asked me to clean up. I cleaned while on my knees. I was so weak and scared,” she narrates.

The doctor then asked her to climb on the same bed to finally attend to her. “I was clueless and didn’t know what to expect. He started hitting my thighs and asked me not be stupid but to follow his instructions. I gave birth almost immediately,” she says.

Her baby came out looking pale and green. “I thought he had died,” she says. 

One doctor told her that the baby had come out the way he did because of exhaustion while in her mother’s womb.

After delivery, she was given ice cold water to freshen up as her baby was taken to a nursery.

“When I came back to the ward, every other person who had given birth received special treatment except me. They were given complimentary items like diapers and I did not get any of those.”

She says that a cleaner who had taken her items treated her with such contempt and even verbally abused her. “I did not react because of fear. She made such vile comments about my age and shamed me for living in a slum. I vowed that I would never go back to that hospital,” she says.

Her second pregnancy came in an unexpected way.

“Raising my child was tough. My elder sister died years after I gave birth and so my other sisters and I had to take care of her three children with my siblings. I had no formal work. My friend asked me to try prostitution,” she says.

“I got my first client in town and he was so harsh to me. He slapped me and dissuaded me from using protection. He raped me. I gave birth to my baby recently and I will never know who the father is,” she narrates.

When she went to deliver her second baby, just like the first one, she says she was ignored and when the baby’s time came, she pushed on her own.

“A mother whose bed was next to mine called the doctors who came after I had already delivered. She saw how I was ignored when I frantically asked the doctors to come and help me before giving birth, but my pleas were overlooked.”

Emily is not the only one.

We find Agnes*, 17, sitting near a local dispensary. She is a few months pregnant and her baby’s father has already denied taking any responsibility. While Agnes hasn’t given birth yet, her experience at the clinics has made her shy away from getting services in public hospitals near her home.

“I learnt about my pregnancy four months into it. I was stunned, sad and confused. My first option was to buy abortion pills. I got them locally but the dosage was not enough. I didn’t manage to terminate the baby,” she says.

Her friend took her to another option, which she says was too scary for her to take the risk.

“I went to this dingy place in our neighbourhood and a man who was to terminate my pregnancy had so many metallic tongs that I learnt would be the tools of trade. I sneaked out and never went back to that place,” she says.

She decided to keep the baby, dropped out of school and started doing menial jobs to get money that would help sustain her and the baby.

“On the first day that I went to a clinic, I found a long queue, but I patiently waited for my turn. The first thing that was off-putting was when the nurses started asking loudly about our conditions. I was not comfortable with that and I wanted a bit of privacy,” she says.

 “When it was my turn, I told the nurse that I had come to start my clinic. She immediately started shouting and judging me for getting pregnant at that age. She questioned why I started interacting with men at my age,” says Agnes*

“I opted to keep quiet. A second doctor came and made the same comments. He asked me to sit next to older pregnant women. This is after I had waited for hours and still did not get what I wanted,” she adds.

When she got to the attending room, they asked everyone how far their pregnancy journey was. She had no clue about her exact time frame because she had just learnt about her pregnancy a few weeks prior to that visit.

“I just left the hospital silently without the doctors noticing. I have never gone back to that hospital since that day and I don’t plan to,” she says.

Her only other option is a private clinic but she doesn’t have money to go to a private hospital all the time.

This means that she will miss some of the essential pre-natal clinics that she should attend.

She got some money and went to a local private clinic and that is when she learnt that she was five months pregnant.

“I sometimes think that the money I use at a private hospital should be channelled elsewhere. Since I am technically a single parent, I should be saving that money for my baby’s needs,” she says

“There is no privacy at a public hospital, I cannot go back there,” she adds.

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 The United Nations International Children’s Emergency Fund data shows that globally, about 13 per cent of girls became teen mothers in 2022. 

The Kenya Demographic Health Survey shows that about 15 per cent of Kenyan girls aged between 15 and 19 had ever been pregnant when the survey was conducted in the same year.

A study published in the British Medical Journal conducted in Kenya’s informal settlements details the mistreatment adolescent mothers go through.

It shows different forms of abuse that adolescent mothers go through, concluding that it deters them from going to hospital.

The study shows that almost all the girls (98 per cent) went to a level three hospital. It indicates that one in every three girls had encountered physical abuse. Other forms of abuse in the study include stigma, verbal abuse, discrimination, neglect and abandonment during childbirth, no bed during childbirth or labour and sharing of beds.

“Mistreatment and abuse of adolescent girls during childbirth are common in the study setting and are associated with lower levels of satisfaction with care, intention to use the facility for future births or willingness to recommend the facility to others,” explains the researchers.

“The results of our study suggest the need to reinforce providers’ training on respectful maternal healthcare in the study setting,” they add.

Why is the study important?

Dr Caroline Kabiru, senior research scientist with the Africa Population Health Research Centre  who was part of the study, says that most of the time, when people think about mistreatment of mothers in hospital, it’s only the adults that come to mind and not the teenagers.

“As we are thinking about the Sustainable Development Goals (SDGs), which also include a target around reducing maternal morbidity and mortality, we need to think about adolescent mothers,” she says.

“Teenagers struggle with both the pregnancy, giving birth and also being adolescents and all that it comes with. We need to ensure that young mothers are supported.”

 She says it is important for girls to give birth in a hospital if the country hopes to reduce maternal mortality or morbidity as well as improve child health outcomes.

“If girls are having negative experiences in hospital and then they are less likely to use facilities, that’s a problem,” she says

“Some girls may decide to give birth at home without someone who is skilled and that can impede the progress that we are hoping to make in terms of improving maternal health and child health,” she explains.

But where is the problem?

While Dr Kabiru and colleagues’ study didn’t quite delve into the root cause of the mistreatment, she believes that it is caused by multiple reasons.

Dr Kabiru says the country has great policies, but we need to implement most of them and ensure that they work well.

“You may find that healthcare providers are sometimes overburdened or underpaid. At the same time, some are coming from a place where for a young person to have sex and therefore present as being pregnant, it is going against social norms of acceptable behaviours of adolescents,” she says.

“When we think about addressing this issue. It is more than just training. Of course training to be respectful is important but we have to look at the healthcare system as a whole,” she says.

Community Health Promoters’ perspective.

Consolata Hela has been a Community Health Promoter (CHP) since 1998 and in all those years, she has helped teenage mothers navigate through the hard times.

“Most young mothers are usually left alone. In the slums, what I have observed is that most of the young mothers were also birthed by young mothers. The mistreatment in hospitals makes them go to local midwives and some end up dying,” says Consolata

She says that as CHPs, they are trained to look for such young people and try to befriend them so they can interact with them freely.

“At first they usually feel ashamed because of the verbal abuse they get in hospitals. When we hear such a thing, we follow up and take them to hospital,” she says.

“I would like to encourage young mothers that regardless of the treatment they get in hospitals, it is still safe to give birth in hospitals. I noticed that when we accompany the teenage mothers in hospitals, the services are better than when we go alone,” adds Consolata.

She advises nurses to try and talk to their ‘clients’ in a humane way because they are the reason they are employed.

“Any child under the age of 18, if you don’t treat them like fragile people, they will not open up. Any pregnant person, young or old, is easily angered…imagine now a young person who has not seen the world,” she says. 

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