ANALYSIS: Much ado about the wrong numbers – decoding Kenya’s teen pregnancy ‘surge’
With schools in Kenya closed until 2021, parents would be forgiven for being apprehensive following an avalanche of local reports about a “spike” in teenage pregnancies.
Not to be left behind, international media reported “a surge” and claimed the country “has for long grappled with high teenage pregnancy rates”.
The resulting fierce debate about a “crisis” saw the president and his ministers wade in. The National Crime Research Centre, a state agency, is now investigating the issue.
But Africa Check found these claims are severely undermined by weak data.
Interestingly, despite a campaign against teenage pregnancy having been launched earlier in the year, the debate ignited after a June 2020 online news story reported that 4,000 schoolgirls had become pregnant since March in the eastern Kenya county of Machakos. Kenyan schools have been closed since March to stem the spread of the Covid-19 pandemic.
The figure was attributed to the county children’s officer commenting on the International Day of the African Child. Africa Check has asked the official to clarify their remarks and we will update this article when we receive a response.
Kenya’s health ministry, however, refuted the figures. The numbers were “exaggerated, outrageous and do not reflect the actual statistics”, it said, estimating the correct number of pregnant teenagers as “a third” of the cases reported in the media.
The ministry’s chief administrative secretary said the Machakos data had been “inaccurately extrapolated”. The 4,000 figure did “not represent the numerical count of individual teenagers presenting to the clinic” with new pregnancies, said Dr Mercy Mwangangi. Instead it was of “multiple visits” of pregnant girls to hospitals, Alfred Mutua, the governor of Machakos county, said.
The ministry said: “This by no means suggests that we do not have a problem in our hands. As a matter of fact, teenage pregnancy remains a global challenge, and Kenya is no exception.”
According to Kenya’s 2019 population census, there were 153,974 girls aged 10 to 19 in Machakos county, which had a population of 1.4 million. Nationally, some 5.7 million girls were of this age.
The United Nations in turn claimed 152,000 girls in Kenya became pregnant in the three months since the start of the national lockdown. The UN reported this was “a 40% increase in the monthly average”.
Why is the data that is key to the debate so confusing? We went in search of answers.
The data about teenage pregnancies in Machakos was drawn from the Kenya health information system. This system gets data from health facilities in the country’s 47 counties and works on an open-source software platform used in 54 countries. Access to the database is determined by the health ministry.
This system is the main and most regular source of routine health data for the country and it is used in all counties, Dr Bernard Onyango told Africa Check. He is a senior analyst with policy think tank African Institute for Development Policy and has experience in demographic and health surveillance research.
Onyango confirmed the figures for Machakos county were as reported in the media. But the data, which covers ages 10 to 19, also showed there wasn’t a national increase in teenage pregnancies in the first five months of 2020 when compared to 2019. Kenyan law defines a child as anyone under 18.
For Machakos, there was actually a decrease during the first five months of the year, from 4,710 in 2019 to the reported 3,966 in 2020. Nationally teenage pregnancies also fell, from 175,000 in 2019 to 151,000 in 2020. This is close to the 2020 figure reported by the UN, though it does not back up the agency’s claim that it represents “a 40% increase in the monthly average”.
The numbers are described as teenagers “presenting with pregnancy”, Onyango said. “This means a pregnant person went to a health facility and the facility recorded the pregnancy.”
There is a significant caveat with these numbers, experts told Africa Check.
The data does not capture all pregnancies because not all people go to health facilities, said Onyango, adding that it was also not clear whether the girls were there for their first visits or for subsequent visits.
Dr Yohannes Wado specialises in population and reproductive health at the African Population and Health Research Center in Nairobi. He flagged the same concerns.
The data from the health information system only captures information about people who go to health facilities or cases that are reported, Wado said. Because not everybody goes to health facilities, the data may be incomplete or there may be the possibility of overcounting when someone makes multiple visits for the same service.
The health ministry said that because of the high risks associated with teen pregnancies, teen mothers are advised “and usually make” several visits to health clinics.
But the ministry also argued that because teenage mothers tended to visit health facilities when their pregnancy was advanced, it was unlikely that the closure of schools had led to any rise in reported pregnancies.
Samuel Cheburet is head of the civil registration and vital statistics unit at the ministry. He said that how the data was collected led to uncertainty.
The data collection tool “should capture only a new adolescent pregnancy” but it did not, resulting in double counts, he told Africa Check in an email.
Other government officials, like the minister for social services Simon Chelugui, have also reportedly said that the lack of coherent data is a concern.
For the most recent reliable data on teenage pregnancies you have to go back six years.
The Kenya Demographic and Health Survey 2014 focused on teenage girls aged 15 to 19 years. Childbearing begins early in Kenya, the survey said, with almost a quarter of women giving birth by age 18 and nearly half by age 20.
Published in December 2015, it found that 18%, or about one in every five, of this age group was pregnant or had had a child. This proportion had not changed since the previous survey was done in 2008/09. This particular statistic has also been widely cited in the media.
The survey added that “the percentage of women who have begun childbearing increases rapidly with age, from about 3% among those age 15 to 40% among those age 19”.
Only another demographic and health survey will have newer information, Zachary Mwangi, the director general of Kenya’s national statistics office, told Africa Check. He confirmed the agency did not have more recent data.
Since 1989, the demographic and health survey has been conducted at intervals of between four and six years. The next edition is planned for the current financial year 2020/21, Mwangi said.
World Bank data, citing demographic survey data for teenage mothers aged 15-19, gives a similar figure of 19% for Kenya. The data is incomplete, but a check shows there are a number of other countries with much higher shares.
Of the countries with data from 2014, these include Mozambique (46%), Sierra Leone (36%) Madagascar (39%), Mali, Chad (both 36%), Angola (35%), Liberia (34%) Bangladesh (31%), DR Congo (27%) and Burkina Faso (25%).
The available data includes those aged 18 and 19, who are legally adults in Kenya. Why is there concern about pregnancies at this age?
“Those under 20 are more likely to have premature deliveries and other complications for reasons including an underdeveloped pelvis and nutritional deficiencies,” Onyango told Africa Check.
“The risk may not be as high compared to younger ages, but it is still a concern.”
Onyango also cited the socio-economic penalties. “For example, a pregnancy for an 18- or 19-year-old girl may curtail her education, compared to a boy the same age.
This leads to gender inequalities at levels of higher education and ramifications for future earnings, he said. The World Bank adds that infants of adolescent mothers are also more likely to have low birth weight, which can have a long-term impact on their health and development.
In order for public debate to be well informed and for policy interventions on such an important issue to be effective, it is central that the issue of incoherent and poor quality data is addressed.
UPDATE: This article was updated on 04/09/2020 to clarify quotes made by two experts.
Carlos Mureithi is a journalist based in Nairobi, Kenya. Additional reporting by Alphonce Shiundu
Not to be left behind, international media reported “a surge” and claimed the country “has for long grappled with high teenage pregnancy rates”.
The resulting fierce debate about a “crisis” saw the president and his ministers wade in. The National Crime Research Centre, a state agency, is now investigating the issue.
But Africa Check found these claims are severely undermined by weak data.
Interestingly, despite a campaign against teenage pregnancy having been launched earlier in the year, the debate ignited after a June 2020 online news story reported that 4,000 schoolgirls had become pregnant since March in the eastern Kenya county of Machakos. Kenyan schools have been closed since March to stem the spread of the Covid-19 pandemic.
The figure was attributed to the county children’s officer commenting on the International Day of the African Child. Africa Check has asked the official to clarify their remarks and we will update this article when we receive a response.
Health ministry claims numbers ‘exaggerated, outrageous’
Kenya’s health ministry, however, refuted the figures. The numbers were “exaggerated, outrageous and do not reflect the actual statistics”, it said, estimating the correct number of pregnant teenagers as “a third” of the cases reported in the media.
The ministry’s chief administrative secretary said the Machakos data had been “inaccurately extrapolated”. The 4,000 figure did “not represent the numerical count of individual teenagers presenting to the clinic” with new pregnancies, said Dr Mercy Mwangangi. Instead it was of “multiple visits” of pregnant girls to hospitals, Alfred Mutua, the governor of Machakos county, said.
The ministry said: “This by no means suggests that we do not have a problem in our hands. As a matter of fact, teenage pregnancy remains a global challenge, and Kenya is no exception.”
According to Kenya’s 2019 population census, there were 153,974 girls aged 10 to 19 in Machakos county, which had a population of 1.4 million. Nationally, some 5.7 million girls were of this age.
The United Nations in turn claimed 152,000 girls in Kenya became pregnant in the three months since the start of the national lockdown. The UN reported this was “a 40% increase in the monthly average”.
Why is the data that is key to the debate so confusing? We went in search of answers.
Machakos figures correct, but don’t show increase
The data about teenage pregnancies in Machakos was drawn from the Kenya health information system. This system gets data from health facilities in the country’s 47 counties and works on an open-source software platform used in 54 countries. Access to the database is determined by the health ministry.
This system is the main and most regular source of routine health data for the country and it is used in all counties, Dr Bernard Onyango told Africa Check. He is a senior analyst with policy think tank African Institute for Development Policy and has experience in demographic and health surveillance research.
Onyango confirmed the figures for Machakos county were as reported in the media. But the data, which covers ages 10 to 19, also showed there wasn’t a national increase in teenage pregnancies in the first five months of 2020 when compared to 2019. Kenyan law defines a child as anyone under 18.
For Machakos, there was actually a decrease during the first five months of the year, from 4,710 in 2019 to the reported 3,966 in 2020. Nationally teenage pregnancies also fell, from 175,000 in 2019 to 151,000 in 2020. This is close to the 2020 figure reported by the UN, though it does not back up the agency’s claim that it represents “a 40% increase in the monthly average”.
The numbers are described as teenagers “presenting with pregnancy”, Onyango said. “This means a pregnant person went to a health facility and the facility recorded the pregnancy.”
Under-reporting likely
There is a significant caveat with these numbers, experts told Africa Check.
The data does not capture all pregnancies because not all people go to health facilities, said Onyango, adding that it was also not clear whether the girls were there for their first visits or for subsequent visits.
Dr Yohannes Wado specialises in population and reproductive health at the African Population and Health Research Center in Nairobi. He flagged the same concerns.
The data from the health information system only captures information about people who go to health facilities or cases that are reported, Wado said. Because not everybody goes to health facilities, the data may be incomplete or there may be the possibility of overcounting when someone makes multiple visits for the same service.
The health ministry said that because of the high risks associated with teen pregnancies, teen mothers are advised “and usually make” several visits to health clinics.
But the ministry also argued that because teenage mothers tended to visit health facilities when their pregnancy was advanced, it was unlikely that the closure of schools had led to any rise in reported pregnancies.
What leads to data deficiencies?
Samuel Cheburet is head of the civil registration and vital statistics unit at the ministry. He said that how the data was collected led to uncertainty.
The data collection tool “should capture only a new adolescent pregnancy” but it did not, resulting in double counts, he told Africa Check in an email.
Other government officials, like the minister for social services Simon Chelugui, have also reportedly said that the lack of coherent data is a concern.
What does the most recent and reliable data show?
For the most recent reliable data on teenage pregnancies you have to go back six years.
The Kenya Demographic and Health Survey 2014 focused on teenage girls aged 15 to 19 years. Childbearing begins early in Kenya, the survey said, with almost a quarter of women giving birth by age 18 and nearly half by age 20.
Published in December 2015, it found that 18%, or about one in every five, of this age group was pregnant or had had a child. This proportion had not changed since the previous survey was done in 2008/09. This particular statistic has also been widely cited in the media.
The survey added that “the percentage of women who have begun childbearing increases rapidly with age, from about 3% among those age 15 to 40% among those age 19”.
Only another demographic and health survey will have newer information, Zachary Mwangi, the director general of Kenya’s national statistics office, told Africa Check. He confirmed the agency did not have more recent data.
Since 1989, the demographic and health survey has been conducted at intervals of between four and six years. The next edition is planned for the current financial year 2020/21, Mwangi said.
How does Kenya compare internationally?
World Bank data, citing demographic survey data for teenage mothers aged 15-19, gives a similar figure of 19% for Kenya. The data is incomplete, but a check shows there are a number of other countries with much higher shares.
Of the countries with data from 2014, these include Mozambique (46%), Sierra Leone (36%) Madagascar (39%), Mali, Chad (both 36%), Angola (35%), Liberia (34%) Bangladesh (31%), DR Congo (27%) and Burkina Faso (25%).
| Adolescents fear hospital visits The World Health Organization, or WHO, recommends that pregnant women visit a hospital at least eight times during a pregnancy to reduce perinatal mortality. Before 2016 the health agency recommended four visits. The Kenya demographic and health survey 2014 showed that only 4% of women aged 15 to 49 failed to visit an antenatal clinic even once. This is the most recent data on Kenya, Dr Bernard Onyango, a researcher with the African Institute for Development Policy, told Africa Check. First-time pregnant teens may fear punishment and stigma if their families, friends or schools learn of their pregnancy, Onyango said. They may also feel judged by other women at the clinic or by health service providers, he added. Those from poor backgrounds may also fear they cannot afford the cost of the services or of travelling to a far-away clinic. |
Older teens still at risk from pregnancy
The available data includes those aged 18 and 19, who are legally adults in Kenya. Why is there concern about pregnancies at this age?
“Those under 20 are more likely to have premature deliveries and other complications for reasons including an underdeveloped pelvis and nutritional deficiencies,” Onyango told Africa Check.
“The risk may not be as high compared to younger ages, but it is still a concern.”
Onyango also cited the socio-economic penalties. “For example, a pregnancy for an 18- or 19-year-old girl may curtail her education, compared to a boy the same age.
This leads to gender inequalities at levels of higher education and ramifications for future earnings, he said. The World Bank adds that infants of adolescent mothers are also more likely to have low birth weight, which can have a long-term impact on their health and development.
In order for public debate to be well informed and for policy interventions on such an important issue to be effective, it is central that the issue of incoherent and poor quality data is addressed.
UPDATE: This article was updated on 04/09/2020 to clarify quotes made by two experts.
Carlos Mureithi is a journalist based in Nairobi, Kenya. Additional reporting by Alphonce Shiundu
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