Why Health Ministry must retrace its steps in making policies

Over a couple of years now, the Ministry of Health has shown incredible support for young people as they navigate through their lives and grapple with sexual and reproductive health. issues. A close reading of the national guidelines for the provision of adolescent youth-friendly (YFS) in Kenya confirms this claim. The ministry through this guide acknowledges that the provision of reproductive health services to young people is rather sensitive as a result of traditional and cultural orientation. A section of society fears that the provision of such services may encourage sexual activity among young people. This fear according to the Ministry’s guidelines has been addressed through research and found to be untrue/ unfounded.

The ministry as demonstrated above must be applauded for relying on both scientific and non-scientific research in its interventions and programming on young people’s sexual and reproductive health issues. Without a shadow of a doubt, adolescents and young people’s lived realities have featured significantly in the development of other ministry’s documents such as the Adolescent’s Package of Care in Kenya that guides healthcare providers in providing healthcare to adolescents. One can only suspect that close consultations with other government entities such as NASCOP and the involvement of young people as the reasons the ministry may have come up with such a comprehensive guide.

I mention NASCOP above because of the significant attention placed on reproductive health services to be provided for adolescents living with HIV(ALHIV) in the package of care. The package of care in an attempt to expand the accessibility of services for ALHIV services acknowledges the practical implications of insisting attainment of consent in HIV management. The package of care guides healthcare providers not to miss out on any opportunity to provide access to comprehensive health services for an adolescent who visits a health facility. As if the direction is not clear, the package further guides that in the case of testing, that adolescent, a legal guardian or parent may provide consent. That, ‘Adolescents aged less than 18 years may be tested with the consent of a parent or guardian, or may give their own if they are symptomatic for HIV, pregnant, married, a parent, or engaged in behaviour that puts them at risk of contracting HIV.’

This momentum towards accessible, available services may however not be sustained if the reproductive health policy 2022-2032 is to be implemented. The policy by the Ministry of Health stands in stark contrast with the previous policies and guidelines including the policy it was seeking to replace. One keeps wondering what might have happened when the revision of the RH policy began, ‘did the ministry start questioning evidence it had relied on in the past? Did the lived realities of young people stop counting?

The Ministry of Health through the Reproductive Health Policy 2022-2032 and particularly about the adolescents’ and young people’s health places additional barriers to accessing sexual and reproductive health services by emphasizing parental consent for persons seeking reproductive health services in cases where they are below 18 years. The policy domiciled at the Ministry of Health and not that of the Interior or education steers as far away as it can from providing direction on RH services under the guise of prioritizing abstinence and delayed sexual debut for persons yet to attain full cognitive competency stated at 21 years.

While at it, the policy references statistics indicating that during the 5 years under review, uptake of modern contraceptives among married women between 15 -49 years had increased from 32% in 2003 to 39% in 2008/09 in 2014 with significant variances between countries. By solely relying on the statistics referenced in the policy document, one keeps wondering who in the context of the 15-year-olds that are married is supposed to give consent; could it be the parents/ guardians of the 15-year-old i.e. where she lived before marriage or the spouse they are currently married?

The danger in employing a ‘protectionist,’ approach as is the case in the RH policy where little to no effort is made in giving direction on access to SRH services lies in eroding many gains made by the Ministry in addressing challenges through its aforementioned efforts. The Ministry must consider its guidance found in the national guidelines for adolescent-friendly services indicating that providing reproductive health services does not increase sexual activity and that the provision of reproductive health services to young people with little barriers only improves their overall wellbeing.

Wangari Ireri is the Programs Manager at TICAH