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Migrants in Need: COVID-19 and the Impact on Labor Migrants’ Health, Income, Food and Travel

PEAH is pleased to cross-post an article by AFEW partner organization. AFEW is dedicated to improving the health of key populations in society. With a focus on Eastern Europe and Central Asia, AFEW strives to promote health and increase access to prevention, treatment and care for major public health concerns such as HIV, TB, viral hepatitis, and sexual and reproductive health

First published August 3, 2020 

By Olga Shelevakho 

and Helena Arntz

AFEW International

Migrants in Need: COVID-19 and the Impact on Labor Migrants’ Health, Income, Food and Travel

 

“I lost my job in Russia due to the COVID-19 pandemic and I didn’t have any money to send back to my mother in Tajikistan who is taking care of my children. I don’t know how to help them”

This is one of many stories from Tajik migrants who have lost their job in Russia in the last months and can’t go back to their families. Some of them have to stay in Russia in poverty and some are stranded at the borders or are staying in unsanitary conditions with hundreds of other people without food, money or shelter. Government help is not enough in this situation, which is why NGOs in Russia and Kazakhstan have taken on the responsibility of helping migrants.

For reference

Russia alone hosted around 12 million labor migrants in 2019, which include an estimated 3 million migrants from Uzbekistan and 1.2 million from Tajikistan. Hoping for better chances of finding a job, migrants from Central Asia migrate mostly to Russia and Kazakhstan. Labor migrants from Central Asia significantly contribute to the economies of these two countries, as well as to the economy of their country of origin. That makes migrants an important part of the international economy, however society’s attitude towards migrants still remains bad.

Lockdown in Russia

At the end of March 2020, the Russian government announced that all non-essential businesses would be closed and suspended all international civil aviation travel. These travel restrictions, put in place to stop the spread of COVID-19, have a severe impact on migrants’ lives. Due to the pandemic regulations, an estimated 83% of the migrants lost their jobs and many of them were not able to return home. In March, 200 Central Asian migrants were stuck at Moscow Domodedovo airport for two weeks and 300 Kyrgyz nationals stuck at the Novosibirsk airport went on hunger strike. Hundreds of people who were trying to go home to Uzbekistan, Tajikistan or Kyrgyzstan by car got stranded at the border.

As many factories and companies stopped working, a lot of migrants lost their jobs and had no money for basic items. When big cities such as Moscow closed down as a result of the COVID-19 pandemic, a pass system was introduced to stop people from going outside. Labor migrants had great difficulty obtaining these passes, as migrants needed to have an officially registered job to be able to receive them. This means that undocumented migrants weren’t able to go out, which caused great difficulties in accessing social and health services. This has serious implications for migrants living with HIV, who cannot get their ARV therapy.

With regards to COVID-19 care, the Russian government announced that it’s free for everyone, even if a person is undocumented. During quarantine there was a moratorium on eviction from Russia, even for people without documents.

Liudmila Vins, the director of NGO “Luna” (Yekaterinburg):

“A migrant who owns a small bakery fell ill with coronavirus. His entire family and workers, also migrants, including illegal immigrants, were tested for free. They started a period of self-isolation, and the bakery was temporarily shut down. The owner of the bakery received all the benefits that were due to him as a small business owner”.

Families in need

The travel restrictions have not only impacted the lives of migrants, but also their families back in their home countries, who depend on incomes from seasonal labor. Especially for a country such as Tajikistan, where remittances made up 32% of Tajikistan’s GDP in 2018, this is a massive blow to its economy. Numbers from the International Organization for Migration show that 51% of Central Asian migrants make regular money transfers to their homeland. Of these, an estimated 80% were unable to transfer any money at the end of April 2020. The lockdown in the host countries thus also places a heavy burden on the families back in the home country.[1] The main problems Central Asian migrants face is not being able to pay their rent (64%), not being able to find a job (45%) and not being able to pay for food (43%).[2] The Russian government decided to compensate migrants for their loss of income, without much success, firstly because the vast majority of labor migrants work in the informal sector, which makes them ineligible for compensation or unemployment benefits. Secondly, the maximum payment by the Russian government to compensate for loss of income of officially registered migrants is 12,130 rubles a month (less than 160 euros), which is not enough not for the migrants themselves to survive, and definitely not enough for them to send money back to their families at home.

Children

Children of “unwanted” migrants are another big problem, according to human rights activists. When undocumented migrants are arrested by the police, they are taken to temporary detention centers. In some regions children of migrants are placed in a shelter for this time, while in Yekaterinburg they are taken to the Detention Center together with their parents. In these centers migrants are kept in separate locked cells. Each cell has several rooms of different sizes, which can accommodate from 4 to 12 people, and sometimes more. One person should have at least 4.5 square meters, but the centers are often overcrowded, especially after police raids.

Who can help migrants?

Despite many restrictions, several civil society organisations have mobilized their resources to help migrants during this difficult time. Kazakh NGO “Zabota”, managed to provide migrants information and recommendations by phone. Some NGOs received small grants from EFCA (Eurasia Fund of Central Asia) for the emergency project “Qolda”. In the framework of this initiative packages with food, hygiene and protection items such as masks were delivered to families of migrants residing abroad. Local ethno-cultural associations and diasporas also didn’t leave their nationals without help. In Russia, NGO “KOVCHEG Anti-AIDS” helps migrants such as Anna who live with HIV receive their medication from its reserve cabinet. They created a mobile point called “trust” so they could continue to meet migrants during the lockdown.

Anna (32 years old) from Ukraine: “I’ve had HIV since 2017. I went to Krasnodar, Russia, with my husband in 2014 where I worked as a housekeeper and my husband at a construction company. Every six months we went to Donetsk to get therapy and take tests. In December 2019, I got pregnant and in March after the borders were closed, we could not go back for the treatment. It was impossible to leave Russia, and I couldn’t interrupt treatment because of the risk of HIV transmission to my child. As a result of the pandemic, the organization where I worked was closed, and my husband and me were told to stay home.  I applied to the Krasnodar AIDS Center for therapy, but they couldn’t help me. Then I found the contact of NGO “KOVCHEG Anti-AIDS” in Rostov on Don, which helped with the therapy”.

In Tajikistan, people are starting to feel the consequences of the lack of remittances normally sent back by their relatives. Since the start of the pandemic, the costs of basic food items have been rising and many families cannot cover basic needs such as food. Thanks to NGOs, people got some supplies. NGO “Nakukor”, with the help of IOM Tajikistan and AFEW International, have distributed food packages to 500 migrant households in the Kulob region, providing families with basic supplies.

NGO “Luna” in Yekaterinburg mobilized resources to provide migrants with masks and hygiene kits. “Luna” has also helped several migrants to obtain residence permits and to register for an apartment. Recently, after borders reopened, some labor migrants left Russia and flew back home, primarily due to fear of infection.

Support NGOs

In April, President of Russia Vladimir Putin announced a support package for socially oriented NGOs and volunteers. The support package consists of seven items such as additional payments to employees of social institutions, grant support for volunteers as well as direct support for NGOs to help them pay salaries. Some NGOs have been exempted from taxes for the quarantine period.  Obviously, NGOs are playing a very important role in helping migrants during this pandemic. They should also be prepared for the reduction in remittances to the poorest Central Asian states to have implications on society and poverty in the long term. This will become clear in the coming months and years. The work of NGOs should not be underestimated and these organisations should continuously receive support to help people in need.

 

[1] IOM Central Asian and Russian Federation strategic preparedness and response plan: Coronavirus disease 2019, February – December 2020, updated on 27 April 2020.

[2] “Influence of the COVID-19 Pandemic on the Position of Migrants and Remittances in Central Asia” by Sergey Ryazantsev and Marina Khramova. Institute for Socio-Political Research of the Russian Academy of Sciences, Department of Demographic and Migration Policy at MGIMO University.

PEAH News Flash 393

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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Toto Care Box: Enhancing Maternal and Newborn Health in Kenya

In Kenya, maternal deaths account for 14% of all deaths to women aged between 15-49 years according to the Kenya Demographic and Health Survey (KDHS, 2014). Neonatal mortality rate stands at 22 deaths per 1000 live births, a proportion calling for urgent action. The number of children dying in the country is used as a marker of social well-being and national development. It is a reflection of the country’s healthcare system and can be used to evaluate the health policies. Like many other health indicators, the burden of maternal and newborn mortality is heaviest among the poor. In the context of urban informal settlements, indicators such as low use of health services and increasing child mortality suggest that the urban poor are a highly vulnerable and marginalized group. Also, with 17 women dying daily in the country during childbirth, all efforts should be directed towards targeted solution finding and implementation of a sound maternal health system. Toto Care Box Africa Trust is a non-profit organization making great strides in bettering maternal health outcomes for poor and underserved women in the Kenyan informal settlement areas since 2016. To date the organization has been able to secure the lives of more than 5000 women and newborns including the poor, those living with HIV/AIDS and the homeless. Additionally the organization has stimulated partnerships in the healthcare system by incorporating the work of various health facilities and corporates in the fight against maternal and newborn deaths. Every mother matters and each newborn deserves a dignified and equal start to life

By Reagun Andera Odhiambo

M & E and Grants Officer at Toto Care Box Africa Trust

 

 Toto Care Box: Enhancing Maternal and Newborn Health in Kenya

 

 

INTRODUCTION

The state of maternal and newborn health in the Kenyan context

Kenya, just as other low-and-middle income countries of the Sub-Saharan Africa continues to realize modest maternal and newborn health outcomes. Sub-Saharan Africa had the highest Neonatal Mortality Rate (NMR) globally in 2018 at 28 deaths per 1000 live births according to the World Health Organization (WHO). A number of factors can be directly linked to these outcomes which are often marked with loss of lives, high maternal and neonatal morbidities and other life-long consequences on the lives of the affected.

In Kenya, the recommended and ideal maternal and newborn care remains only available for the elites and those in the high socio-economic class; those who can pay for health services. The remaining majorities only seek basic care in order to survive and are thus predisposed to poor maternal and newborn health outcomes which may lead to preventable deaths and morbidities. Worse even, some shun from seeking basic healthcare for reasons of poverty and stigmatization; they depend on fate for survival. In Kenya 39,000 newborns die annually due to preventable causes. Also, 17 women die daily during childbirth due to lack of lifesaving education. There is urgent need for all efforts to be directed towards curbing this preventable problem endemic in our country.

MAJOR GAPS IN MATERNAL AND NEWBORN HEALTH IN KENYA

The unacceptably high maternal and newborn mortality rates in Kenya relate to a number of factors which should form the basic action points for preventive solutions by key stakeholders in the health sector. Many gaps can be identified through an exploration of the state of maternal and newborn health in Kenya:

Health-service delivery gaps

According to the 2014 Kenya Demographic and Health Survey (KDHS), only 61% live births occurring in Kenya are delivered in a health facility. 62% are assisted by a skilled provider and 53% of women receive a postnatal care checkup. Also, one in three newborns receives postnatal care from a doctor, nurse or midwife. With regards to vaccination coverage, only 79% of children (12-23 months) receive all basic vaccines. These statistics reveal the underlying gaps in access and utilization of essential maternity services by the public.

Many health facilities charge highly for various maternity services including emergency obstetric care. This makes the services less affordable and inconvenient resulting in an overall low uptake. Poor health infrastructural development marked by fewer health facilities in highly populated regions also causes accessibility problems which translate to poor maternal and child health outcomes. A number of facilities have few qualified staff with many unskilled attendants who put women and newborns at risk. All these service delivery factors collectively derail the efforts towards curbing maternal and newborn deaths in the country.

Environmental gaps

Expectant women and infants suffer the greatest brunt of ill-health in Kenya as a result of unfavourable environmental factors. The harsh environmental conditions in which infants are born make them vulnerable to malaria, diarrheal diseases, neonatal sepsis and respiratory infections. Informal settlement areas for instance are overcrowded with poor air quality as a result of poor waste disposal, scarcity in clean water supply and poor drainage. All these contribute to unhygienic conditions which make it hard to care adequately for newborns.

The situation is worsened by negative cultural beliefs and practices such as early marriages, emphasis on home deliveries and traditional cures. Data shows that some expectant women living around health facilities do not utilize Maternal and Newborn Health (MNH) services because of misleading cultural beliefs advocating for home-based care by elders; who in most cases are untrained.

Knowledge/Awareness gap

Despite the fact that majority of Kenyan women at least attain secondary education, most of them have little knowledge and awareness on many aspects of maternal and newborn health and overall reproductive health. This predisposes them to the risk of pregnancy-related complications and other sexual and reproductive health issues. The women may prove clueless when it comes to issues of family planning, breastfeeding, hygiene, proper nutrition, antenatal care, postnatal care, immunization among others. Knowledge plays a critical role in the maternal and newborn health outcomes of individuals and thus it remains a key factor at play amid the high mortality rates being witnessed.

MATERNAL/NEWBORN HEALTH AND THE VULNERABLE

Various categories of vulnerable women respond differently to their maternal and newborn health needs in Kenya. This is dependent on the prevailing conditions and the resilience of the affected individuals in coping with unforeseen events. A number of vulnerable groups and their typical responses in the utilization of maternal and newborn health is discussed below:

The poor and underprivileged

Poverty remains a great hindrance to good health and well-being particularly maternal and newborn health. Lack of finances to pay for vital health services leaves many women helpless when it comes to access and utilization of emergency obstetric care. For reasons of poverty and lack of essential newborn care commodities (baby clothes, soap, diapers etc.), majority of women forego hospital-based care. They feel stigmatized for showing up in health facilities with no basic newborn care items at the time of delivery. Also, poor women find it hard to access highly nutritive foodstuff during the pregnancy and postnatal period. This leaves them at risk of nutritional disorders and deficiencies which might have a reflection on the health and well-being of their newborns. There is an overall increased likelihood of low uptake of facility-based care among poor women in comparison to rich women.

Teenage mothers

Teenage mothers are made vulnerable by the event of childbirth at a very young age which research confirms can be lethal and with lifelong consequences. In most cases, teens are clueless on almost all aspects of maternal and newborn health owing to their low literacy levels. They have limited knowledge and are just in the discovery face of life where sexual and reproductive health issues can be overwhelming to them. Typically, such young and vulnerable mothers shun from seeking medical care for reasons of fear of judgement and stigmatization. Some develop suicidal feelings especially those who become pregnant as a result of sexual abuse and molestation. They often miss their antenatal care appointments some even delivering their babies at home. The fear of bringing up a child single-handedly and possible termination of their education also causes anxiety for most of them. This reduces their morale and consistency in seeking maternal and newborn care in health facilities.

Slum dwellers

Informal settlement areas otherwise referred to as slums remain high risk areas when it comes to maternal and newborn health. These areas are characterized primarily by overcrowding, poor sanitation, poor housing conditions, inadequate fresh water supplies and high rates of social crimes all of which make it hard to offer or practice ideal maternal and newborn care. Slum dwellers due to congestion are mostly unemployed hence high dependency ratios remain endemic in such areas. That means that majorities cannot pay for essential maternal and newborn health services leave alone putting food on their tables.  The areas have poor infrastructural statuses which make it hard, even impossible to access emergency obstetric care and other vital health services.

Typically, slum dwellers give preference to their survival (food and shelter) with little or no concern for their maternal and newborn well-being which is viewed as a secondary need and less important. They should however not be faulted for this because they are often left with no other options but to survive. It is because of this reason that health facilities continue to report few antenatal care contacts and hospital deliveries in such areas. Consequently, preventable maternal and newborn conditions such as pre-eclampsia, gestational diabetes, malaria, pneumonia and diarrhea remain endemic in the areas resulting in high mortality rates.

Mothers living with HIV/AIDS

HIV/AIDS has a great bearing on the maternal and newborn health statuses of women and children. The affected women need specialized care during pregnancy. This helps secure their newborns while at the same time safeguarding the health of the mother from opportunistic infections and childbirth-related complications. Prevention of mother to child transmission of the virus should be prioritized at all times. Women living with HIV/AIDS may fear to seek facility-based obstetric care for reasons of stigmatization or mistreatment. They may feel overwhelmed with the whole idea of prevention of mother to child transmission of the virus and thus need counselling and personalized user-friendly care. They may find it hard to consistently attend their antenatal care appointments, for this reason they need to be encouraged to adhere to ANC attendance recommendations. This can be achieved through incentivization and adoption of user friendly maternal health services.

Refugees and the homeless

Being homeless or in a refugee setting leaves many expectant women and newborns at risk for many preventable infections and possible death. Such individuals may lack almost all basic necessities including food, shelter, clothing and even security and are thus vulnerable. Refugees often have no access to quality maternal care and they may end up delivering their newborns without the assistance of health professionals. Antenatal care is absent for most of them. For the homeless, sleeping outside in the cold affects their health drastically resulting in infections which affect their pregnancy outcomes and the overall health of their newborns. Such individuals need assistance in seeking maternal care and finding comfortable housing facilities.

THE TOTO CARE BOX SOLUTION

Toto Care Box history

The Toto Care Box story began in 2012 in a little village called Marich in West Pokot, when Lucy Wambui Kaigutha (the founder) was working as a Public Health researcher collecting data on Integrated Management of Childhood Illnesses (IMCI). She had to conduct focus groups amongst women from this village. One mother stood out to her, she had five children, her fifth barely two weeks old and she had nothing. This woman stayed in Lucy’s mind long after she came back from West Pokot. She knew she needed to do something for the mother and her baby. One day she stumbled upon an article, “Why Finnish babies sleep in cardboard boxes” as she was browsing the internet and that was the inspiration for the Toto Care Box. In Finland, babies have been sleeping in cardboard boxes since 1939 after the Second World War as a government initiative to reduce maternal and infant mortality. Currently, Finland has the lowest maternal and infant mortality in the world. Lucy then decided to create the Toto Care Box tailored to suit the Kenyan needs and bring about similar outcomes. This would later be adopted for other high need African countries the aim being to save at least one million maternal and newborn lives in Africa by 2022.

How Toto Care Box promotes maternal and newborn health

Toto Care Box provides a simple but unified solution to the maternal and newborn mortality problem among vulnerable and underserved community members. This is achieved through a community-based integrated model bringing together health facilities, Community Health Volunteers (CHVs) and the target women. The main goal of the program is to increase access and uptake of quality life-saving maternal and newborn health services. The program is therefore important for a number of reasons; it provides a framework for achieving both the sustainable development goal and the Big 4 agenda related to maternal and newborn health. It is also critical in strengthening the health system through stimulating partnerships among the stakeholders in health. The program’s nature of working at the grassroots helps find more sustainable solutions which can be replicated in other high need areas in the country.

Toto Care Box addresses community maternal and newborn health needs in three major ways:

PROVISION – 18 maternal and newborn essentials are given to vulnerable women and newborns in order to prevent maternal and newborn deaths.

INCENTIVIZATION – women receive a Toto Care Box after attending at least four antenatal care visits and delivering in a health facility.

EDUCATION – women are educated on fundamentals of maternal and newborn care including danger signs during pregnancy and for the newborn, exclusive breastfeeding, proper hygiene, cord care and prevention of common newborn illnesses.

The program is guided by four core objectives all of which aim at reducing maternal and newborn deaths:

To incentivize women to attend at least four antenatal care visits.

These help in early detection and prevention of pregnancy-related complications such as hypertension and pregnancy diabetes both of which can dramatically affect the fetus. Early detection means regular monitoring and treatment.

To incentivize women to deliver in health facilities.

Facility deliveries by qualified birth attendants help reduce the chances of childbirth complications which often result in the death of a mother, her newborn or both.

To reduce the four major causes of newborn deaths (malaria, neo-natal sepsis, pneumonia and diarrheal diseases).

This is achieved by providing 18 low-cost, high-impact maternal and newborn essentials for the optimum survival of newborns.

To provide up-to-date maternal and neonatal information to women to ensure birth preparedness and effective childbearing.

This is done through mass education, Toto Care Box maternal and newborn care training as well as childbirth classes by Lamaze certified facilitators.

Solution targets

The Toto Care Box program prioritizes informal settlement areas of Kenya as well as other disaster prone and high need areas for its intervention. This is mainly because such areas are faced with serious problems when it comes to accessibility, affordability and acceptability of maternal and child health services and essentials. The areas are often characterized by poor living conditions and residents have high illiteracy levels and a diminished ability to make healthy choices. The primary beneficiaries are poor and underserved women and newborns but the program impact is generated at both household and community levels.

Impact

Currently, the Toto Care Box program works in 9 high need areas in Kenya and serves over 5000 underprivileged women and newborns. Through the program, a number of partnerships both local and global have been made aiming the betterment of maternal and newborn health outcomes for the poor. Also, the program has made great strides in impacting the lives of teen mothers and their newborns as well as mothers living with HIV/AIDS. Our hope is to give every newborn an equal and dignified start to life.

Call for support

We appeal to every interested persons, groups and organizations to support our highly potential cause (Toto Care Box) to reach out to other needy women. Support can be in form of financial assistance, donation of individual items (baby clothes, soap, diapers etc.), partnering in what we do, purchasing Toto Care Boxes for women or sharing our work with potential funders and donors. Feel free to reach out to us through the below contacts:

Website www.totocarebox.org

Email totocarebox@gmail.com

Phone +254701945110/ +254719313712

 

Conclusion

Evidence generated from the impact of the Toto Care Box program in Kenya reveals that maternal and newborn deaths can be prevented, reduced and even eradicated through simple but targeted interventions. Multi-factored and unified approaches need to be implemented especially in high need areas through synergistic partnerships by all the stakeholders in health. It is only through such client-centered methods that we will be able to secure our maternal and newborn health individually, communally, regionally, nationally and even continentally. Let us all strive to give each newborn a dignified and equal start to life.

 

PEAH News Flash 391

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 391

 

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Beyond The Biological Basis Of Disease, The Intersection Of Medicine, Social Sciences, And Indigenous Knowledge 

Why do bats have so many viruses? 

Coronavirus disease (COVID-2019) situation reports 

Latest COVID-19 Statistics from African Countries 

Lockdown, Relax, Repeat: How Cities Across The Globe Are Going Back To Coronavirus Restrictions 

African Union aims to scale up COVID-19 vaccine clinical trials 

COVID-19 Vaccine Nationalism Limits Africa’s Options 

Almost 10m children may never return to school following the pandemic 

WGH India Dialogue Series: Amplifying the engagement of Female Frontline Health Workers in India’s COVID-19 Response 

Contribution of the COVID-19 Crisis to Teenage Pregnancy Upsurge: a Case of Mukuru Kayaba Slums, Nairobi Kenya by Reagun Andera Odhiambo

Financialization: Tackling the Other Virus 

How Senegal is Providing Reproductive Health Services to those Who can Least Afford it 

NCD Alliance Launches New Fund With Pharma To Bolster Prevention & Treatment Of Chronic Illnesses – That Exacerbate Risks From COVD-19 

In The Shadows Of COVID-19, A Devastating Epidemic Rages On 

Importance of medicine quality in achieving universal health coverage 

Pakistan to resume polio vaccination campaign months after it was halted by coronavirus 

MSF: Urgent call to oppose dismantling of US asylum system 

More than 22,000 students and teachers harmed or killed in attacks on education in last five years 

Evaluation of systems reform in public hospitals, Victoria, Australia, to improve access to antenatal care for women of refugee background: An interrupted time series design 

Beating the Drum: Stories of Influencing Networks 

As more go hungry and malnutrition persists, achieving Zero Hunger by 2030 in doubt, UN report warns 

‘Completely off track’: World hunger numbers rise for 5th straight year 

Q&A: Understanding COVID-19’s Impact on Food Security and Nutrition 

Sea Change in Sight in the Fight Against Global Forest Crimes 

EU action ineffective in safeguarding wild pollinators, say EU auditors 

A new prescription from medical professionals across Europe to tackle air pollution 

‘Not all biomass is carbon neutral’, industry admits 

Climate change: ‘Rising chance’ of exceeding 1.5C global target 

 

 

 

Contribution of the COVID-19 Crisis to Teenage Pregnancy Upsurge: a Case of Mukuru Kayaba Slums, Nairobi Kenya

According to the 2014 Kenya Demographic and Health Survey (KDHS), 1 in 5 Kenyan teenage girls is a mother. Also, statistics by the United Nations Population Fund (UNFPA) indicated that between June 2016 and July 2017, 378,397 girls got pregnant before their twentieth birthday in Kenya. Similarly, 379,573 teenage girls were made pregnant by the end of last year as reported by the National Council on Population and development (NCPD). These huge numbers cause devastation bearing in mind that they were reported during normal times. What then are we to expect with the new normal where essential functions and healthcare services have been greatly compromised by the Covid-19 pandemic?

By Reagun Andera Odhiambo

M & E and Grants Officer at Toto Care Box Africa Trust

Contribution of the COVID-19 Crisis to Teenage Pregnancy Upsurge

A Case of Mukuru Kayaba Slums, Nairobi Kenya

 

Early estimates by a number of local and global health organizations point towards a potential increase in indirect mortalities caused by the Covid-19 pandemic. Among the areas that are expected to be greatly affected in this regard are Sexual and Reproductive Health (SRH) as well as maternal and newborn health. Disruption of essential health services and the subsequent inaccessibility by those in need is a direct effect of the Covid-19 pandemic which seemingly generates lethal outcomes.

To explore Covid-19 outcomes on the health of adolescents and young people, my attention has been drawn to teenage pregnancy. This is an endemic problem greatly rooted in our country just as in other middle and low income countries which is bound to escalate with the current crisis.

According to the 2014 Kenya Demographic and Health Survey (KDHS), 1 in 5 Kenyan teenage girls is a mother. Also, statistics by the United Nations Population Fund (UNFPA) indicated that between June 2016 and July 2017, 378,397 girls got pregnant before their twentieth birthday in Kenya. Similarly, 379,573 teenage girls were made pregnant by the end of last year as reported by the National Council on Population and development (NCPD). These huge numbers cause devastation bearing in mind that they were reported during normal times. What then are we to expect with the new normal where essential functions and healthcare services have been greatly compromised by the Covid-19 pandemic?

The Covid-19 pandemic brings with it massive consequences directly, indirectly and in multi-factored ways. The indirect consequences are mainly triggered by the breakdown of essential health services including SRH services such as family planning and maternal and newborn health. With the current lockdown, curfew and cessation of movement directives by the government, access to and provision of essential reproductive health services is interfered with and somehow compromised for both users and providers. Teenage girls and young women are part of those affected because they need these services.

According to Plan International, Covid-19 related school closures hit girls the hardest. This is because being out of school increases teenage girls’ vulnerabilities to not just early and unwanted pregnancies but also to early marriages or contraction of Sexually Transmitted Infections (STIs) including HIV/AIDS. Also, with schools closed, young girls are shut up at homes where they are faced with an increased risk of sexual exploitation and gender-based violence all of which may result in unwanted pregnancies.

With the current emphasis on “staying at home”, teenage girls and their male counterparts find themselves with plenty of uninterrupted time where they get to engage in experimental sexual activities in a curious exploration of their sexuality and the fulfilment of the demanding needs of their fast growing bodies. All these fun-filled explorations may go unnoticed only to be revealed a while later by “missing periods” or “a growing bump” otherwise said to be an unwanted pregnancy.

Teenage pregnancies have been proven to cause serious negative impacts on the lives and future of the affected girls especially with regards to their overall health as well as mental and social well-being. Teen mothers less likely continue with their pursuit of education and thus end up in poverty which comes with both depression and rejection. Some teens decide to terminate their pregnancies not looking at the numerous risks they present themselves to by choosing the risky procedure. Abortions are the second leading cause of death for girls 15-19 years of age and leave the victims who survive with lifelong complications including fistula. Worse even, some take their lives for fear of judgement and feelings of guilt.

Mukuru Kayaba, an informal settlement forming part of the larger Mukuru slums extending through Kwa Ruben and Kwa Njenga areas is one area that has been hard hit by the teenage pregnancy crisis over time.

The area just like other slum areas is faced with numerous problems relating to poverty and over congestion such as poor housing, high unemployment and dependency ratios, strain on available resources including essential healthcare, insecurity and high disease burden and prevalence.

Barely four months of the Covid-19 pandemic seems to produce an alarming upsurge in the number of teenage pregnancy cases being reported both to the local authorities in the area and to the health facilities offering maternity and other reproductive health services. Toto Care Box, an NGO working with women and newborns in the area reports an overwhelming demand for their services and products at this critical time and this is attributable to the rising number of cases of teenage pregnancy. At this point am tempted to imagine about the real iceberg lying in the unreported cases as well as those attempting to or already successful in termination of these unwanted and unplanned for pregnancies. Is there need for alarm?

Almost all the forty seven Counties in Kenya have been hard hit by the teenage pregnancy crisis. Latest statistics reveal that Nairobi County tops the list with 11,795 girls aged between 10-19 years reporting to be pregnant between the months of January and May this year. Here is the distribution for top ten counties as per the June Report on the state of teenage pregnancy in the country:

Direct causes of this sudden upsurge in the number of teenage pregnancy cases being reported can be explained using Covid-19 pandemic as the core trigger.

Depressing economic times such as the one presented by the Covid-19 pandemic are known to push teenage girls from poor families into sexual activities in exchange for food and other forms of necessities including protection from suffering. Most often, this type of vulnerability is hard to prevent because the victims are pushed to the limits and have no other options left. A number of studies point out to the fact that sexual exploitation in the context of sex in exchange for food and other essentials is widely reported as vulnerable girls and their families struggle to meet basic needs especially in times of crisis. This could be a perfect reality of what is being experienced by the suffering Kayaba residents.

Findings by the National Council for Population and Development (NCPD) support my hypothesis by confirming that approximately 26% of teen girls from poor households experience teenage pregnancy in comparison to 10% belonging to wealthier households. Poverty is actually a factor at play in Mukuru.

Also, as earlier mentioned in the article, the Covid-19 containment measures currently in place constrain teenage girls at home presenting them with enough free time to find innovative ways to experiment sex unnoticed. The “stay at home” directive therefore greatly helps flatten the Covid-19 curve while exponentially increasing the teenage pregnancy curve. Is the directive to be blamed in any way?

Teenage pregnancies have the cumulative effect of perpetuating the cycle of poverty which consequently lowers individual, social and economic development.

Toto Care Box is an organization working with poor women including girls in the Kenyan slums to better their reproductive health outcomes. The organization provides support to teenage girls undergoing the teenage pregnancy crisis by encouraging them to carry their pregnancies to term, to attend antenatal clinics, to deliver in health facilities and to care adequately for their teens despite the stigma, negative judgement and rejection.

This is done through a community-based approach involving education and incentivization. The organization does not however support the idea of young girls engaging in risky sexual behaviors that predispose them to early unwanted pregnancies. Visit www.totocarebox.org for details.

In conclusion, successful efforts to curb teenage pregnancy must address underlying drivers through programs such as behavior change, sex education, social and economic development, reproductive rights advocacy and health systems strengthening. With all that in mind I still remain with a number of unanswered questions; Who is to be blamed for the teenage pregnancy problem? Who are the male perpetrators and what consequences do they face for their actions? What role do parents play in solving the crisis? How many teens will be affected by the end of the Covid-19 pandemic?