When teen mothers are left to die

Mella (name changed to protect her dignity) knew she was pregnant when she missed her periods for two months in a row.

She was upset, hopeless and terrified. She was only 18 and lived with her mother at Korogocho slum, in Nairobi County.

“How could I be pregnant at this time? This is the end of my future. My mother is very harsh, how am I going to tell her I’m pregnant?” she wondered.

She had just received her Kenya Certificate of Secondary Education results and had scored a C minus. She hoped to build a career in a profession that “would involve a lot of travelling.”

As she struggled to come to terms with this information, more bad news was to follow.  Her boyfriend denied any knowledge of the pregnancy!

She detested her pregnancy and decided not to attend prenatal clinic in the hope that the baby would die inside her womb.

“I wanted to abort but then I was scared. I asked myself ‘What if I die in the process of terminating the pregnancy? I'll miss the delicious ugali,’” she laughs off her predicament.

Prenatal care

“I tried to abort using tea leaves. It didn’t work. I never went for prenatal care. In my heart, I was asking God to kill the child in my womb. The child had come to ruin my future.”

For months, she denied being pregnant when her mother asked. And all through the time, she suffered in silence as the negative thoughts flipped through her mind.

But at seven months, she would not hide her pregnancy anymore. The baby bump was bulging.

“I was sure my mother already knew I was pregnant. So this time, when she asked me, I accepted. She was very bitter. She scolded me for being dishonest. She later calmed down and told me to start attending prenatal clinics at Dandora Health Centre. But I didn’t until I started experiencing labour pains,” she says.

Her mother accepted the pregnancy and is now her best friend. Her daughter is two months-old and she says, she has bonded with her and loves her so much.

There is something, however, that troubles her; the baby is the exact replica of her father, a fact that hurts her so much considering that he rejected the pregnancy, she says.

“My mum always tells me to forget about him and move on with my life,” she says.

Esther* is not as lucky as Mella though.

She is a housewife. She was forced to find solace in a marriage at the age of 17 years when she fell out with her maternal grandmother.

She also lives in Korogocho slum. She says she was in Form Two when her grandmother stopped paying her school fees.

Her granny took her in when her parents separated and ‘abandoned her.’

When she got pregnant she needed someone to talk to.

First time

“During my pregnancy, I wished I had a brother or sister with whom I'd share my experiences. A friend comes and goes but a family member will remain forever,” she says.

“Here I was pregnant for the first time, I didn't know what to do, and I didn't know whom to talk to. I needed someone who could understand me.”

Now, with a month-old daughter, Esther* wishes she had a family member to walk with her in her motherhood journey.

She says although she feels sad about her situation, she has opted to “harden up and leave everything to God.”

“I'm not happy being idle. I’d love to buy my daughter something with my earned income,” she says.

Her husband has been the only friend she opens up to, she says.

She bursts into a dejected laughter when I ask her if her grandmother ever visits or rings her to check on her.

“She doesn't,” she says.

Rejection and isolation

“After I gave birth to my daughter at Korogocho Health Centre, I called her with the good news. She asked me where I was and I gladly informed her hoping to see her, but she never came. And she has never called me since,” she says.

Mella and Esther fall in the category of adolescent mothers whose mental health is largely neglected. Their experiences manifest mental health issues that teen mothers struggle with pre-and postpartum, yet families and society continue to smack them with rejection and isolation, painfully driving them to their death beds.

Pregnancy among the 10–19-year-olds in Kenya, is popularly known as teenage pregnancy, and this is the variation used by the Ministry of Health in recording the number of pregnant girls seeking prenatal and postnatal services.

Teenage pregnancy and motherhood rate in Kenya stands at 18.1 per cent, according to the 2014 Kenya Demographic and Health Survey, the most recent government data.

The United Nations Population Fund puts the figure of 10-19-year-old girls visiting Kenyan hospitals annually with pregnancy at 300,000.

But even with the high number of teenage pregnancies, the mental health of these human beings carrying little ones in their wombs is given least attention.

Dr Estelle Sidze, a maternal and child health specialist at African Population and Health Research Centre (APHRC) says 25 to 40 per cent of the women in Africa suffer from baby blues.

Stigmatisation

She, however, says pre- and post-partum depression among women and girls in Africa is under-studied.

The maternal and child health specialist says adolescents are more susceptible to mental ill-being considering the high level of stigmatisation they are subjected to.

“Their parents chase them away. When she goes to her boyfriend’s, he also sends her away. The school says, ‘go away because you are showing a bad example to others,’ or nobody wants to hire them because they are pregnant. This leaves them in the darkest state of mind.”

She also observes a major shift in how the family and community interact with the adolescents which further harms their mental well-being.

“Nobody asks them how they feel; their experience of being a mother or how they are coping. The questions are (all) about how the child is,” she notes.

She warns against stigmatisation and isolation of teen mothers. And worst still, ignoring their mental well-being.

“Studies have shown that depressed women or adolescents don’t seek health services. This is very dangerous; they can experience complications during delivery which could have been prevented during ante-natal visits,” she says.

This was the case for Mella who kept off prenatal hospital visits.

“They also don’t take their children for immunisation or breastfeed them, yet it is important for the proper development of a child,” she says.

APHRC has developed a toolkit informed by the experiences of adolescents in informal settlements in Nairobi.

Stress management

The toolkit, administered by a trained member of the community or household, helps the girls and women cope with pre- and post-partum depression.

It helps in gauging their mental status by asking questions such as; “In the last seven days have you felt like you’re always tired? Do you feel like crying? Do you feel like not eating and not doing things that you previously enjoyed doing?”

It also provides stress management options like speaking with family members and friends. But in the case where their status has deteriorated to a psychosis level, then they are directed to a clinical psychologist.

Child and adolescent therapist Venoranda Rebecca Kuboka says teenage mothers are helpless in the face of stigma and rejection.

“They are afraid to seek help because society will brand them mad-they end up depressed and finally commit suicide,” she says.

She says depression can be tracked over a period of three to six months.

“Depression does not begin with pregnancy. It builds up from the point when one was either defiled or had to stop schooling due to pregnancy,” she says.

In 2019, suicide was the fourth leading cause of death among 15-29 year-olds globally yet suicides are preventable with timely, evidence-based and often low-cost interventions, according to World Health Organisation.

The child and adolescent therapist recommends setting up designated clinics for adolescents where they can undergo comprehensive assessment.

“Having such a system can help identify a teenager with a mental health disorder and treat her before the disorder advances to a complex stage,” she says.

In the meantime, she encourages teen mothers never to shy away from seeking help.

“I also appeal to parents and family members to offer a strong support system to the teen mothers to save them from drowning in being a mum,”

They can also do things that give them hope and joy like taking a walk or doing yoga to relieve themselves from any mental suffering, she advises.

Adolescent mothers

The Ministry of Health (MoH) identified only one existing initiative designed to address the mental health of teen mothers.

“MoH works with partners to address MH (mental health) of teen mothers-out of this, there is Tabasamu Café, an initiative, which gets funded by non-profits (and) is aimed at building awareness around mental health and supporting adolescent mothers in Nairobi,” read a feedback from the Division of Mental Health in response to the query of efforts made by the ministry to address the mental health of teen mothers.

Ignoring the mental health of adolescent mothers has a ripple effect on the wellbeing of the future generation.

Two foreign students Manasi Kumar and Keng Yen Huang did a research on the impact of being an adolescent mother on subsequent maternal health, parenting, and child development in Kenyan low-income and high adversity informal settlement context.

From their research a total of 394 mothers with two-16 years-old children who sought maternal and child health services at Kariobangi and Kangemi public health centres between October 2015 and April 2016, were studied.

Their findings published on April 1, 2021 in PLOS One, a peer-reviewed open access scientific journal, indicate that adolescent pregnancy has negative consequences on women’s adulthood health. And this negatively impacts their children’s physical and mental health.

Based on the findings, they recommend provision of integrated care that addresses the health and parenting needs of the adolescent mothers. This, they say, would in the long-term optimise development of their children.

For now, Emily* gives a sense of what it means to have a strong and reliable support system.

At 17 years, while in Form Three, she was impregnated by her boyfriend who later disassociated himself from the pregnancy. At the time, she lived with her mother in Korogocho slum.

Her mother, whom she describes as a drunkard, had no particular interest or sympathy when she informed her of her status.

“Not a single day did she enquire about my wellbeing,” says Emily who notes that she was neither in speaking terms with her father. She says she disliked him for reasons she preferred not to talk about.

Commit suicide

“We saw each other in the morning on her way out to the drinking den and when she returned home drunk at night. She would hurl insults at me. Sometimes, I felt like beating her up but stood guarded by my respect for her as my parent,” she says.

At some point, she wanted to commit suicide but then a thought crossed her mind “hold on, stay a live to take care of your child.”

Her maternal grandmother lived nearby and she was kind to her. She was the one she would open up to whenever she needed a shoulder to cry on. She reminded her to go for the prenatal visits at Korogocho Health Centre.

When her mother decided to move to another place within the slum, she opted to remain with her grandmother.

“My mother created a toxic environment and I didn’t want my child to grow up in that kind of environment,” she says. She finally delivered a healthy baby boy.

For her grandmother, she is full of praise.

“My grandma is my everything. She is always there to listen to me and support me and my three-year-old son. I say ‘thank you grandma.’ I'm so grateful to her. She makes me feel at peace and have a reason for living,” she says.

This story was produced with the support of Voice for Women and Girls' Rights-Kenya, a Journalists for Human Rights project.

[email protected]