Adolescents are believed to be senior children who are transitioning from childhood to adulthood.
The National Adolescent Sexual and Reproductive Health Policy 2015 provides for Adolescent age to be between the age of 10-19 years while The Reproductive Healthcare Bill (2019) provides the age of adolescent to range between 10 years to 18 years.
This group of individuals need a trusted source of information on reproductive health care given in a prescribed form to prevent other sources that might mislead or misguide them. The bill’s main objective is to ensure the protection and advancement of reproductive health rights for every person, among other provisions, giving emphasis on the sexual reproductive health of adolescents. The bill derives its mandate from the Constitution of Kenya under;
- Article 43(1): Every person has a right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.
- Article 26(4): Abortion is not permitted unless, the mother’s life is endangered by the foetus, or it’s an emergency treatment, or if the foetus may suffer some abnormalities that is incompatible with life outside the womb., or where its permitted by any other written law.
ADOLESCENT FRIENDLY REPRODUCTIVE HEALTH SERVICES
The bill tends to implement The National Adolescent Sexual and Reproductive Health Policy, by providing Adolescent friendly reproductive health services and advocating for age appropriate comprehensive sexual education in school curriculums. Adolescent friendly reproductive health services include:
- Mentorship programs
- Spiritual and moral guidance
- Counselling on; abstinence, consequences of unsafe abortion, STI’s and HIV/AIDS, drug abuse and vocational training,
- Training on life skills and livelihood.
Such services shall be offered by a qualified person to adolescents. The health care provider shall get the guardians consent before providing age appropriate information and reproductive health services to the adolescent.
The ministry of health and education shall Integrate age appropriate syllabus appropriate information on reproductive health in education curriculum.
In addition to Article 26(4) the bill allows abortion to a pregnant minor (below 18 years). The practitioner must obtain consent from the parents/guardian and it has to be in the best interest of the minor.
A medical practitioner shall give informed information and counseling before and after conducting an abortion. The medical practitioner is also required to perform post abortion care, counseling, deal with matters of incomplete abortion and complication arising out of abortion procedure.
The difficult question that needs to be answered by the bill is, what prevails in cases where, it’s the best interest of the pregnant minor to procure an abortion but the guardian or parent does not give the consent. My view, the best interest of the child should always prevail to the consent as provided for in the Constitution under Article 53 (2): A child’s best interests are of paramount importance in every matter concerning the child and its backed up by the Children’s Act,
CAN A MEDCAL PRACTITIONER REFUSE TO PERFOM AN ABORTION?
A medical practitioner shouldn’t refuse to carry out an abortion if;
- It’s an emergency
- The life of the mother is endangered due to the pregnancy
- There is substantial risk to the foetus to suffer mentally or physically which is incompatible with life outside the womb.
Save for the emergency reasons, a medical practitioner may refuse to carry out an abortion on one main condition, that, they have to refer you to a qualified medical practitioner who is willing to carry out the abortion, without any form of discrimination or judgment.
The bill basically requires the medical practitioner to at least know a qualified person who is willing to carry out an abortion if he/she can’t do it.
The bill goes ahead to compel the medical practitioner to refer the concerned mother to the other willing qualified practitioner, failure to which he/ she risks a jail term of 2 years or a fine of 2 million or both upon a conviction.
This regulation protects the pregnant minor from resorting to unsafe abortion methods or unqualified persons and it also reduces the trouble of finding a qualified practitioner who can successfully perform the abortion. The stigma involved into finding the willing qualified medical practitioner to perform an abortion is therefore reduced by the bill.
The question that the bill needs to answer is what happens if the medical practitioner does not know anyone in his/her circle that can actually perform an abortion successfuly, does he/she still get persecuted for this?
GENERAL GUIDELINE ON REPRODUCTIVE HEALTH CARE SERVICES
On a general note, the Bill requires the Central Government and the County Government to put in place ante-natal, postpartum, prenatal, family planning methods and counselling in all national referral services available for all beneficiaries.
Concerned parties should be provided for the following information by the reproductive health care giver, before offering the service;
- Available reproductive methods
- Advantages and disadvantages of each method
- Which method can work best on the party all factors considered?
- The cost of treatment and the best facility to offer such treatment.
Any information given, shared, recorded under the bill should be held in confidence at all cost, save for exceptions provided under the bill. Any contravention made shall result to a disciplinary committee with the relevant disciplinary committee.
The bill provides for the creation of awareness of parents and teachers on sexual education and the adolescent sexual reproductive services, its benefits to the adolescent’s education, health and growth.
All persons affected under the bill have general rights under it, which rights must not be denied at any time. They include;
- The right to confidentiality and privacy on their reproductive health,
- The right to access reproductive health care services without discrimination and,
- The right to information and services concerning their reproductive health.
Generally, the bill addresses most of the unwanted pregnancies cases among adolescent, by providing adolescent friendly reproductive services.
With all the complications faced by children raising children in the country, its only safe for the bill to first consider the best interest of the child upon the assessment and confirmation of the medical practitioner. If the risks involved are high, then the consent of the guardian or parent may only be secondary to the best interest of the pregnant minor.
Also, in cases of adolescent reproductive healthcare services, the consent of the parent may not be required since the services offered are already safe and such information is essential to any adolescent who is transitioning to an adult, just like studying reproductive system does not require consent.
The bill is silent on the fact that some adolescent, with the consent of the guardian or parents, may actually require family planning options. This area is not specifically provided for in the bill, which rules out any option of any adolescent accessing family planning options when may actually be in need.