Family planning is widely cited as one of the “best buys” in global development, a relatively low-cost, high-impact intervention offering transformational benefits to individuals, their families and communities. In low- and middle-income countries, where pregnancy is the leading cause of death among girls aged 15 to 19, increasing access to and uptake of modern contraceptive methods among adolescents can save lives. And yet meeting the reproductive health needs of young people remains a persistent challenge.
Recently I had the opportunity to meet with three youth champions working in and around Nairobi to empower young people to take charge of their reproductive health. All three individuals – Ann Mitu, Mary Wanjiku Mwangi and Francis Shawn Wambua — unexpectedly became parents at a young age. Their insights reinforced for me that in order to bridge the access and service gaps, and reach targets set by the FP2020 movement, we will need to ensure that the specific needs of adolescents are understood and addressed.
Here are some highlights from our conversation:
Q: What are the greatest challenges you face as an advocate for youth and family planning, and how have you worked to overcome them?
Ann: One challenge is convincing young mothers that their life dreams are still valid. There are so many teenage moms. We encourage them to return to school, to stay in school and get that certificate. But there is a stigma, and they are ashamed. Many have run away from home. I had my son when I was 19. My baby’s Daddy was supportive, but he passed away. I had to hustle to sell things on the street to survive. For two years I felt lost. So I know what it’s like. It's why I started Young Mothers Africa, to empower my friends. I tell these young mothers, you may not have planned for your first one, but you can plan for your next one.
Mary: We need to change the way providers treat young people who come into their clinics seeking contraception. They are often rude and insulting. They will turn young girls away, saying, 'you are not supposed to have sex at this age, you are not married, you do not have a family, family planning isn’t for you.' This is wrong. Contraception is for everyone. Providers need to acknowledge that young people need these services.
As part of the advocacy group U-Tena, I encourage young girls to delay their sexual debut, by empowering them with information about sexual and reproductive health and rights. But if they are not going to abstain, they need to know how to prevent pregnancy, and providers need to help them do that. I teach them about the different methods and help them find a method they are comfortable with. And when they go to the clinic, I go with them, to make sure they get what they need and what they want. I am also advocating for a name change, from “family planning” to something that resonates with young people, like “future planning.” This would help change assumptions and improve access.
Francis Shawn: I agree we need to change provider attitudes, but we also need to change attitudes in the whole community. Too many people turn a blind eye to the fact that young people are sexually active. Parents don’t talk to their children about it. When my beautiful girlfriend Damaris became pregnant, I was nearly excommunicated from my church. I am working with young men to change their attitudes too. It’s why I started a youth group called Ndugus for Dadas, or Brothers for Sisters in Kiswahili – to encourage male involvement in these issues. I tell other young men my story and say, learn from me; if you are not ready to have a kid, contraception is your responsibility too. I am starting to see change, but it is a continuous process.
Q: How might we drive uptake of family planning services among youth?
Francis Shawn: Most young people have mobile phones and spend most of their time with them – they might be more open talking to a person over the phone about their problems.
Mary: Young people certainly need information, mainly about different kinds of contraception and where to get it. A call-in service that provides information about contraception —and links them to youth-friendly providers — would be empowering for young people. The voice on the other end and the language should not be too sophisticated though – it should speak to youth. Something that works using SMS messaging would be good too, because young people like SMS.
Ann: I also recommend pushing information out using social media. So many young people in Africa are on Twitter, Instagram and Facebook.
Q: What other approaches should we be thinking about?
Ann: Postpartum family planning should be embraced. At the facility where I volunteer, a young mother will come in for her two-week checkup, to get help with feeding and caring for her baby. That is a good time to talk to her. She may not realize she can become pregnant even while she is still nursing. She may not realize the dangers of having babies so close together.
Francis Shawn: Postpartum family planning is very important. After giving birth, the mother is there at the facility and ready to listen. I work with a lot of couples who have already had children. I counsel them about taking their time, to focus on supporting and educating the kids they already have. I am the fourth of five siblings, and we’re all very close in age. The elder ones always told me our family was better off before my little sister and I came along. I don’t want anybody growing up feeling like I did – the result of poor planning.
In 2012, Merck for Mothers’ (MfM) and the Bill & Melinda Gates Foundation (BMGF) made an eight year, $50 million joint commitment to ensure that voluntary family planning services reach an additional 120 million women and girls in the world's poorest countries by 2020. This week, we are gathered together here in London for the 2017 Family Planning Summit to accelerate progress towards this goal. Our success will depend on our ongoing ability to integrate the contributions of youth champions such as Ann, Mary and Francis in the design, creation and implementation of our efforts.
Mary-Ann Etiebet is Executive Director of Merck for Mothers, Merck’s 10-year, $500 million initiative to help create a world where no woman dies while giving life. Merck for Mothers is known as MSD for Mothers outside the United States and Canada. Read more about our work in family planning here.