OSSREA Publications

Willing Fathers, Reluctant Parents
Young Men's Perspectives On Unwanted Pregnancies Aand Abortion In Kenya

Charles Nzioka

Executive Summary

Abortion continues to be a major cause of maternal morbidity and mortality worldwide. In developing countries, abortion is more acute as a public health problem. In these countries, pregnancy-related complications cause one-quarter to one-half of deaths among women of reproductive age. Thousands of women in developing countries also suffer serious pregnancy related illnesses and disabilities, such as chronic pelvic pain, pelvic inflammatory disease, incontinence, and infertility. Worldwide, unwanted pregnancy and unsafe abortion are more acute among young people. In Kenya, where abortion is permitted only to save a woman's life, unsafe abortion accounts for over one-third of maternal deaths and hospital emergency rooms are overcrowded with women suffering complications of induced and spontaneous abortions. Adolescents constitute the majority of those who die or present with pregnancy related complications due to unsafe abortion in most medical facilities in Kenya. These pregnancy-related complications mostly arising out of unsafe abortion place an extra burden on an already overstretched and resource-strained national health care system. The ensuing maternal morbidity and mortality among young women also constitutes a major drain to national manpower resources. To address these pregnancy-related health problems which arise out of unsafe abortions, there is an urgent need for evidence-based research which can produce effective programmatic interventions.

At present, however, most studies appear to focus mainly on the female role and perspectives on unwanted pregnancies and unsafe abortion. Male perspectives and involvement in abortion decision-making processes and abortion procurement are often overlooked. Yet men as sexual partners only contribute to the unwanted pregnancies, and have their own perspectives and role in the management and termination of these pregnancies.

The study was conducted in the newly created Makueni District which has a limited data-profile on the role of young men in reproductive health decision-making processes. The study also sought to build on previous work by the same research team on the wider male involvement in family planning in the District. Initially this study was intended to examine the role of young men in abortion. But as it became increasingly difficult to capture the preplanned data, the study ultimately focused on the perspectives and experiences of young men with unwanted pregnancies and abortion.

Triangulation was used in data collection so as to enrich quality of data. Quantitative data were collected through a survey using a questionnaire from a sample of 333 young men aged 15 – 19 years while qualitative data were obtained through focus group discussions with a purposively selected sample of young men and also through in-depth interviews with key informants among them teachers, parents, local administrators and health providers. Augmentative data were obtained from secondary sources such as government reports and other forms of literature.

The results of this study demonstrate that:

• Some young men are responsible for a proportion of unwanted pregnancies, but accurate data on the level of their involvement in causing these pregnancies is lacking and difficult to capture owing to unwillingness on the part of young men to own up to causing these unwanted pregnancies.
  
• Relatively, few young men are willing to admit playing any role in the abortion procurement decision-making processes.
  
• Young men appear to admit to fatherhood but few are ready to accept parenthood due to the heavy responsibility associated with parenting.
  
• Most young men are aware of the adverse consequences of abortion and do not support or approve of abortion procurement for fear of the possible negative consequences as well as the social stigma associated with abortion.
  
• Young men support their partners into having unsafe abortion for financial resources to secure safe abortion services.
  
• The few young men who admit assisting their partners in procuring abortion also report experiencing high levels of stress arising out of their involvement in abortion procurement.
  
• For most of the young men who have been involved in abortion, the quick recovery of their sexual partner is their most immediate concern.
  
• After the abortion, most young men tend to terminate their relationships with the sexual partners who had aborted as such continued interactions with such partners is a constant reminder of their involvement in abortion.
  
• Young men also see such sexual partners as having acquired a ‘permanently’ blemished character by their act of aborting.
  
• Most unwanted pregnancies are as a result of limited access to quality sexual and reproductive health information and contraception services such as emergency contraception.
  

Deriving from the above findings, this study makes the following recommendations:

As part of building a corpus of knowledge on the role of men in reproductive health decision-making process, there is a need for an expanded national study across various regions in Kenya to examine in greater depth the role of young men in cause and management of unplanned and/or unwanted pregnancies.

Young men (and women) need to easy access to quality reproductive health information and contraceptive options to avert many unwanted pregnancies. In particular, young men need easy access to condoms while young women need emergency contraception so as to avert or reduce possibilities of unplanned pregnancy. Young men may also need knowledge on how to use masturbation as a way of acquiring sexual gratification so as to avert the possibility of causing many unwanted pregnancies.

Young men (and women) need the services of community-based distributors (CBD) of contraceptives such as condoms and emergency contraception so as to avert many unwanted pregnancies. For the effective implementation of the CBD program, these programs need to be manned by their peers.

Young men need to be educated on the anatomy and physiology of women such as ovulation, menstrual cycles and the ‘safe periods’ so that they can better understand how and when to practice sex with their sexual partners which does not lead to unwanted pregnancy.

The government should enhance the job creation capacity for young people especially women so as to empower them to resist unwarranted sexual advances from resourced men which could lead to unwanted pregnancies and also abortions. Economic empowerment of young men would also enable young people access to safe abortion services, if and when any unplanned pregnancies occur.

The government should provide free, user friendly and quality post-abortion care to young people in all its public health care facilities in the country. Such a program would enormously ease the current pressure on young people to seek out abortion services in unhygienic and clandestine sources thus reducing unnecessary maternal morbidity and mortality among young women due to unsafe abortion.

Most health care providers should also be trained on the provision of quality post-abortion care services especially to young women.

Finally, the government of Kenya should decriminalize abortion and put in place more tolerant or liberal legal regime on abortion so as to ease the current pressure on young people to seek out clandestine unsafe abortion in