Why SHA health scheme locks out teenage mothers

When Susan’s 17-year-old daughter started complaining of chest pains, she assumed it was just a minor illness.

She was rushed to Mbagathi Hospital, where Susan was confronted with a brutal truth that left her shaken. Her daughter was five months pregnant.

The girl had been keeping the secret, too ashamed and afraid of stigma to speak up.“My daughter carried the pregnancy in silence, hiding her growing belly under loose clothes. She was terrified of how I would receive the news,” says Susan.

The teenager was eventually enrolled for antenatal clinics (ANC) at the facility.

But as the pregnancy advanced, complications arose. For instance, the baby was not in the right posture, and the teen was diagnosed with anaemia that required treatment.

When the time for delivery came, she was rushed to a nearby private facility, where she successfully delivered at a cost of Sh3,600.

Without health insurance or savings, the mother struggled to raise the money out of pocket.

“I have not registered for the Social Health Authority (SHA) because I have no source of income. I cannot afford the annual premiums. I therefore had to pay the delivery fee out of pocket,” says Susan, a resident of Kawangware who does casual jobs like washing clothes to make ends meet.

To join SHA, Susan is required to pay Sh7,092 in annual premiums, as the newly revised average monthly premium for the scheme is capped at Sh591.

“My casual jobs cannot guarantee me a loan from the Hustler Fund, because I cannot repay it,” she says.

Her daughter’s ordeal in accessing maternal services, compounded by financial struggles, is not unique, as thousands of teenage mothers across the country face similar barriers.

The shift to the new health scheme has left many unable to register, resulting in home deliveries, late hospital visits, and tragically, preventable maternal deaths.

Susan’s story mirrors a bigger crisis in Kenya and beyond.

Globally, teenage pregnancy remains the leading cause of death among girls aged 15 to 19 years, with many succumbing to excessive bleeding caused by uterine tears during childbirth.

Experts attribute this to the fact that their reproductive systems are not fully developed to support safe delivery.

In Kenya, excessive bleeding from uterine tears is one of the greatest threats during childbirth, claiming the lives of at least 10 women every day out of the 21 maternal deaths reported daily.

The country’s maternal mortality stands at 355 per 100,000 live births.

Teenage pregnancy remains one of the most pressing public health concerns in Kenya, with devastating consequences for young girls, their families, and the healthcare system.

Data by the National Disease Control Council (NSDCC) shows that in 2023 alone, at least 252,000 girls between 10 and 19 visited antenatal clinics in the country, representing about 691 cases every day.

This, according to Douglas Bosire, acting NSDCC Chief Executive Officer, is a staggering number at a period when children should be in school.

“A child aged 10 to 19 should either be in primary school, high school or beginning university studies, but instead, we have to take them out of school to manage their pregnancies. And if they are fortunate enough to carry a pregnancy to term, they must care for their children,” says DR Bosire.

Violet Aluse, a Community Health Promoter (CHP) in Kabiro, Kawangware location, Dagoretti North, has witnessed first-hand the toll of teenage pregnancies on young girls in her community.

She says poverty, worsened by the effects of the Covid-19 pandemic, has forced many adolescents out of school and into early motherhood.

“Many under-18 girls are getting pregnant because of lack of school fees. After the Covid-19 pandemic, there were massive job losses, and it has become difficult for families to afford rent, food, or education,” says Aluse.

Most girls discover they are expecting only when they are already five or six months pregnant.

By then, many are anaemic, undernourished, and at high risk of complications.

“At birth, the majority develop problems. They have low blood and risk maternal deaths, including babies dying,” regrets Aluse.

Because their bodies are not fully developed, many teenage mothers cannot deliver normally.

A large number undergo caesarean sections (CS), which come with heavy financial strain.

“CS procedures cost between Sh30,000 and Sh45,000. For families already struggling to put food on the table, this is an impossible expense,” she observes.

Although SHA is supposed to cater for delivery costs, many families cannot afford the annual premium. Some try to borrow from the Hustler Fund but remain trapped in debt.

“The government should allow SHA payments in instalments. Right now, you must pay annually, yet people cannot even afford food. If it were possible to pay as little as Sh300 monthly, many families could manage,” says Aluse.

For now, well-wishers step in to support struggling families, but the need is overwhelming.

Muteithania Nursing and Maternity Director Mercy Mutegi has also seen the struggles of teenage mothers.

Every month, the health facility in Dagoretti attends to at least five adolescent deliveries, some as young as 14.

“It is a big problem.

Most of these girls come to deliver with no funds, yet they are expected to be covered under the SHA. The reality is that many parents have not included them, or the families cannot afford the annual payment,” Mutegi explains.

The gap in healthcare financing leaves many teenage mothers stranded.

Mutegi recalls cases where underage girls are admitted for delivery at Sh3,500, but their parents never return to settle the bill.

“There are a number of cases where mothers ‘dump’ their daughters at the hospital when they develop labour, never to be seen. They then send an auntie to pick them, but the bills remain. This affects us as a facility,” says Mutegi.

Under the Linda Mama programme that was offered under the defunct National Health Insurance Fund, mothers could register their daughters.

“It was almost free. If we could have a similar programme today, it would really help,” she says.

Without financial support, some families resort to unsafe home deliveries, which Mutegi warns is dangerous and risks reversing gains in maternal health.

“We are reporting babies being born at home because facilities demand payment. If a girl is not registered under SHA, the family chooses home delivery.

We need a special fund for adolescents to save lives,” she pleads.

According to Mutegi, many adolescent mothers arrive at the hospital late, having skipped antenatal care visits.

Some present in the second stage of labour, leaving no time for referral.

“They should deliver in bigger hospitals with theatres, but they come late and we have to act. Teenage girls are at high risk of tears and heavy bleeding.

“In such emergencies, I call the sub-county, get free ambulances, and rush them to Mbagathi or Kenyatta National Hospital,” she explains.

The burden is compounded by poverty in the community.

“This is a slum environment. Parents are jobless, doing casual work.

‘‘It’s not their wish to default on payments. It’s their status. We understand them, which is why we don’t chase anyone away. Some pay later, others we waive,” Mutegi says.

Still, the hospital has had to release patients unable to offset bills. Just this month, three teen mothers were discharged without paying.

Mutegi believes policy reforms could ease the crisis. She is urging the government to allow flexible SHA contributions.

“Let families pay monthly, not annually. Even Sh300 a month would help,” she says.

“And let’s revive Linda Mama, or another fund for maternity care. Women will always give birth—we must not let them go back to midwives and unsafe home deliveries.”

Hospital visits for delivery across the respective age bracket at the facility have drastically reduced from 130 births every month to the current 70, as the majority of families are not able to raise the delivery fee.

“Deliveries are always there, but without financial support, more mothers will suffer in silence.

‘‘We need a system that protects women and girls, especially in poor communities,” says Mutegi.

Fredrick Kairithia, an obstetric gynaecologist and public health expert, warns that many adolescent mothers face life-threatening complications during pregnancy and delivery, largely because they are not physically, emotionally, or economically prepared for motherhood.

“Most of these girls should be in school. Even if they consent to sex, and carry a pregnancy, a 14-year-old is not physically mature enough for childbirth,” says Dr Kairithia.