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How a family planning agenda is deciding the future for millions of girls

17-year-old Fatuma and her daughter, Faith - Sarah Newey
17-year-old Fatuma and her daughter, Faith - Sarah Newey

The plastic gems on Fatuma’s pink midi dress sparkle as the bright sunshine streams onto the laughter-filled porch, where the 17-year-old is trading quips, tips and selfies with her friends.

But beneath her carefree smile, there is stress and sadness. She and her three friends are sharing stories, not about school and exams, but birth and motherhood.

“This is my Faith,” Fatuma says, introducing her wide-eyed 18-month-old daughter. “It hasn’t been easy, when I found out I was pregnant I was so scared. The first day she was born, I didn’t know even how to hold a baby.”

Here, in a sprawling coastal town in the heart of one of Kenya’s poorest regions, Fatuma and her friends are not alone in accidentally trading literacy and numeracy for nappies and breastfeeding.

In this region, Kilifi county, roughly 22 per cent of girls aged 15 to 19 are either pregnant or have already given birth at least once – more than double the average across sub-Saharan Africa. In high income countries such as the UK, that figure is just 1.5 per cent.

Sheila, 17, and her daughter Biana. Hope and her mother, Joanne, 24. Fatuma, 17, and Jasmine, 18, with her son Lucien.  - Credit: Sarah Newey
Sheila (17), Joanne (24), Fatuma (17) and Jasmine (18) outside Mtwapa health centre, which hosts the young mothers network. Credit: Sarah Newey

According to Juliet Kimatu – who runs the Mtwapa young mothers network where Fatuma met Jasmine, Joanne and Sheila – high rates of teenage pregnancy here are caused by poverty and compounded by poor education, limited access to healthcare and traditional attitudes towards women.

“You often see girls with two, three, four children before they’re 25,” says Juliet, a programme officer with the International Centre for Reproductive Health. “Many are single mothers and it can be a struggle for them to provide even for themselves, their education was cut short – so how can they support so many?”

Some 300 miles away in Kenya’s capital city, 6,000 people have descended on a vast concrete building resembling London’s Barbican centre this week for a major conference on sexual and reproductive health – and how to keep more girls in school is one of many issues on the agenda.

The Nairobi Summit is a follow up to the International Conference on Population and Development (ICPD) in Cairo in 1994, a landmark event widely credited with establishing a rights based approach to reproductive and sexual health, with women at the center of development.

But 25 years later, despite significant progress, many of the bold promises agreed by 179 countries in Cairo remain unfulfilled. According to UNFPA – the UN’s population agency – roughly 800 women still die from preventable causes every day and 33,000 girls are forced into early marriage, while four million girls are subjected to female genital mutilation each year.

And for more than 230 million women and girls like Fatuma who want to avoid a pregnancy, access to contraception remains out of reach.

Fatuma, 17, is became a single mother 18 months ago - Credit: Sarah Newey
Fatuma, 17, is became a single mother 18 months ago Credit: Sarah Newey

But according to figures released this week, it would cost roughly $264 billion over the next decade to eradicate FGM, maternal mortality and early marriage and provide contraception to all those who want it – a figure the UNFPA describes as a “drop in the ocean”, equivalent to the price of 110 military aircrafts.

“I believe it’s wrong to even refer to this as a cost,” Dr Natalia Kanem, executive director of the UNFPA, told a press conference. “What this represents is an investment in humanity. It is a cost that we cannot afford not to do.”

With over 1,000 pledges of support from NGOs, governments, donors and the private sector so far (including £425 million for UNFPA Supplies from the UK), the conference appears well on its way to generating the momentum organisers hoped for – although some remain cautious.

“It’s been inspiring to hear world leaders commit to this,” Pauline, a 24-year-old representative from Plan Liberia, said. “But we as youth advocates are a little bit worried about whether we will actually see the action and implementation. We have a little bit of fear as these promises were already made 25 years ago.”

And despite all the talk of a renewed impetus at the summit this week, the gathering comes amid concern about the “rollback” of women’s rights worldwide – with critics of the ICPD agenda emboldened by President Donald Trump.

His administration has reintroduced and expanded the so-called “global gag rule”, which is starving charities and agencies – including the UNFPA – of funding across the globe. And at the UN General Assembly in September, the US championed an anti-abortion message.

“You know I think the ‘gag rule’ is very problematic,” said Dr Herminia Palacio, chief executive of the policy organisation Guttmacher Institute. “It means providers have a choice between speaking the truth to their patients or being shut down, sometimes due to funding cuts, and that is an abhorrent position for any clinician to be in.”

The conference mandate this week has attempted to walk a tightrope between anti- and pro- abortion groups, with a focus on ending unsafe terminations through the provision of contraception services, rather than advocating for legal, safe abortions.

A group of anti-abortion protesters gathered outside the conference centre on Monday - Credit: Screenshot from AGENCIA EFE/Daniel Irungu youtube video
A group of anti-abortion protesters gathered outside the conference centre on Monday Credit: Screenshot from AGENCIA EFE/Daniel Irungu youtube video

But on Monday, an anti-abortion group marched through Nairobi’s city centre and accused the summit of having a “pro-abortion and sexualisation agenda”, while small parallel opposition events have been hosted by conservative religious groups.

At the other end of the spectrum, pro-choice organisations have criticised the delicate compromise as ignoring the importance of abortion as part of a “comprehensive” package of services.

“Maybe because of the whole backlash, you don’t hear people use the word abortion a lot,” Helen Clake, former prime minister of New Zealand and administrator of the UN development programme until 2017, told The Telegraph.

“But I don’t think we should shy away from saying that when we say the full range [of reproductive and sexual health services] we really do mean the full range. Women want to have the choice.”

Simon Cooke, chief executive of Marie Stopes International, added that providing legal, safe services does not increase the incidence of abortions.

“When abortion legislation is restrictive, it doesn’t stop women having it done, it just makes them less safe. And that’s fundamentally a bad thing – which can cost a woman her life. We understand the context is difficult, but [at the summit] there has been a tendency to censor out the word [abortion] because of the sensitivities of national governments.”

Kenya itself is among the countries with restrictive termination laws, and the government told a press conference that any discussion about the necessity of abortion services was a “distraction”.

“There are people walking away from this agenda and that is a tragedy,” said Macharia Kamau, principal secretary to the Kenya Ministry of Foreign Affairs. “We see it locally here in groups deliberately misinterpreting the intention of [the ICPD] agenda.

Fatuma and her daughter Hope, with Jasmine, 18, and her son Lucien - Credit: Sarah Newey
Fatuma and her daughter Hope, with Jasmine, 18, and her son Lucien Credit: Sarah Newey

“But all these stories about abortion, they too  are just trying to to distract us from getting on an talking about the business of saving lives. I’ve never known a women who enjoyed an abortion, it doesn’t exist... It’s the last thing a woman wants,” he added.

Back in Mtwapa, abortion was never on Fatuma’s radar – “I always knew I would have the baby”, she says, sitting outside the small red-brick house she shares with her aunt. But neither was contraception.

“If you are a mother at the age of 16, the story has been written for you… a story of a life derailed,” said Dr Kanem. “Family planning is a crucial aspect of giving women and adolescent girls the power to control their future.”

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