Around the world, access to sexual and reproductive health care remains out of reach for many young people. In Kenya, which has the third highest teenage pregnancy rate worldwide, 1 in 5 adolescent girls is already a mother. “Many young people in Migori County live far from health facilities, some have strict parents who are against family planning, some fear being judged by health workers, while others are worried about side effects,” says Sam Oyugi, Lwala’s head of adolescent & youth programs. “These barriers hinder access not only to family planning, but also to other sexual & reproductive health services.”
When young people know about their bodies, are empowered to ask questions and seek support, and have access to services like family planning, we can unlock the door for better health and gender equality. For many years, Lwala has been supporting young people in our communities to make this a reality. We deploy a cadre of young people to serve their peers, we promote high-quality comprehensive sexual education in schools, and we support girls to return to school post-pregnancy. We also provide information and access to a range of modern contraceptive methods, delivered through youth-friendly access points. As a result, women in Lwala-supported communities are 2.6 times more likely to use modern contraception.
At the center of this work is the leadership and knowledge of young people. “I know my peers are more comfortable talking to people who are their own age,” says youth advocate Odera Vincent Ochieng. “We have the ability to understand each others’ problems, figure out a solution, and advocate for change.”
Reaching young people with sexual & reproductive health services
On a Sunday afternoon, two dozen girls gather for a youth outreach event in South Kamagambo. Most are between the ages of 15 and 24, some bounce babies on their laps, and others have come with friends. “I don’t want to get pregnant while I’m in school,” says one girl. “I came here today to ask questions about preventing pregnancy and maybe even start on family planning.”
Hillary Otieno was responsible for planning this outreach event. As one of Lwala’s 113 youth peer providers (YPPs), he is a trusted source of information on sexual and reproductive health for other young people in his community. In collaboration with his local health facility, Kitere, he visits his peers at their homes and organizes outreach events. “Where I live, many young people cannot go to the facility because of long distances and lack of transportation,” Hillary says. “So we talked to our facility in-charge and CHWs. They suggested that we do more outreach events where people can ask questions and access contraceptives closer to their homes.”
The role of YPPs has expanded over time. First, they developed a program called “Dial-a-Condom,” where peers can discreetly order condoms through a phone call or WhatsApp. After years of implementation, YPPs knew that young people wanted more options. So Lwala trained and equipped YPPs to provide oral contraceptive pills and emergency contraception through the same platform. As a result, contraceptives provided by YPPs to their peers have more than tripled since the same time last year.
This year, YPPs had another idea to bridge the gap between services and their peers–it’s called the Roving Provider Initiative. Using their connections with health facilities, YPPs call on trained health providers to come to a safe space in their community, where they can provide methods like injectable contraceptives and implants to youth. “Through coordination and teamwork with the YPPs, we have been successful in helping our young people,” says Susan Akinyi, a nurse at Kochola dispensary who also serves as a roving provider. “Sometimes we travel long distances to meet adolescents where they are comfortable. And if they come to the facility, sometimes we see them after hours when it’s more convenient for them. I always try to put myself in their shoes.”
“I believe that change can be driven by young people. I know my peers are more comfortable talking to other people their age–we have the ability to understand each others’ problems, figure out a solution, and advocate for change.”
- Odera Vincent Ochieng, youth advocate
Mobilizing youth advocates
Lwala recognizes the importance of equipping young people to advocate for themselves and their peers. In early 2021, we noticed a gap in youth involvement in other community committees. “Most community meetings happen when we’re in school,” says Odera. “And even if we do attend, it’s difficult to talk openly in the presence of our parents, aunts, and uncles.”
To fill this gap, we supported the establishment of youth committees, which gather young people to discuss issues affecting them and then escalate problems to duty bearers. In one recent success story, a youth committee noted challenges at Kangeso dispensary. Some felt that health workers had a negative attitude toward adolescents seeking family planning, while others reported breaches in confidentiality–some parents had even been notified.
The youth committee drafted a memorandum documenting their concerns, and they met with the in-charge of Kangeso and the health facility management committee, who promised change. “Today, Kangeso is much more youth friendly,” reports Odera. “Young people no longer shy away from seeking services, confidentiality is a priority, and staff attitudes have improved.”
Youth committees have been established in each of Rongo Subcounty’s 4 wards. Because of their work–and the work of YPPs–there has been a 156% increase in young people under age 25 accessing sexual and reproductive health services at these facilities.
Helping girls stay in school
One of the surest ways to unlock the potential of young girls is to help them stay in school. Through our Broadened Horizons program, we support adolescent girls who have dropped out of school, largely due to pregnancy, to re-enter school. Girls are connected to mentors, who provide guidance and encouragement. These mentors also understand community decision-making structures, and they work to build support among families and spouses for girls to re-enter school. By involving families, we ensure that girls have support systems to help them achieve their goals.
Grace was one of the first girls who enrolled in Broadened Horizons. When she learned she was pregnant, she and her family thought the only option was to get married and leave school. But her friends encouraged her to join Broadened Horizons after she gave birth. She was connected to a mentor, who helped change the perceptions of Grace’s husband and in-laws. The family was also given a small cash transfer to subsidize the cost of childcare while Grace was away.
When she re-entered school, she immediately became a motivated, dedicated student. “Many girls do not get such a second chance–once they get married, very few go back to school. But we made it work.” With the support of her mentor and husband, Grace uses an IUD to prevent another pregnancy until she’s ready.
Grace is now attending a local technical college, and in her free time, she serves as a mentor for other girls in Broadened Horizons–278 are currently enrolled. “I encourage them to use family planning until they are ready to have another child,” she says. Beyond education, Grace sees how this program impacts girls in other ways. “Every day, I can see how their self-esteem grows. We are empowering girls to be in control of their own future.”
Throughout our communities, more and more young people are adopting a core belief summarized by youth advocate Odera: “We believe that we can change our own future. We are not just the leaders of tomorrow–we are leaders today.”