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Gendered Effects Of Covid-19 School Closures: Kenya Case Study, Faith Mbushi, Natalie Wyss, Emily Eunyoung Cho, Karen Austrian, Eva Ireri Muluve, Laura Muthoni, Beth Kangwana

Poverty, Gender, and Youth

This brief summarizes a case study that assessed the gendered impact of COVID-19 school closures in Kenya. COVID-19 school closures escalated education inequalities especially for girls and young people in rural areas. These closures exacerbated adolescent mental health issues, food and economic insecurity, and experiences of violence. COVID-19 response programs implemented by both the Government of Kenya and non-state actors were not able to fully mitigate the impacts of school closures for adolescents, teachers, or schools. Continued efforts to understand the implications of school closures and to support vulnerable students are needed.

Getting Girls Back To School In Kenya: The 4ts ('Trace, Track, Talk And Return') Initiative Implementation Report, George Odwe, Chi-Chi Undie, Ann Gachoya, Truphena Kirongo, Fredrick Kiiru, Jane Njogu

Poverty, Gender, and Youth

The Covid-19 pandemic led to devastating economic and social disruptions globally including in the education sector. The pandemic disrupted access to both sexual and reproductive health services and safe spaces. As a result, many girls faced vulnerabilities that inhibited access to basic education, including risks of child marriage, early pregnancy, gender-based violence, female genital mutilation/cutting, sexual exploitation, and child labor. The negative impact of Covid-19 on girls' education underscores the need for interventions addressing the effect on school re-entry and retention. Kenya has a favorable policy environment for supporting retention within, and re-entry into, schools for vulnerable girls. Notable core …

Endline Results Brief: What Works To Improve Outcomes For Kenya's Adolescent Girls?, Population Council

Poverty, Gender, and Youth

The Adolescent Girls Initiative–Kenya is a study that evaluates the long-term impact of a multisectoral intervention targeted at adolescent girls aged 11 to 15 years from Kibera and rural Wajir. The intervention consists of four components: a community-based violence-prevention program, an education conditional cash transfer (CCT), health-focused girls-empowerment clubs, and wealth creation for girls via financial education and savings. A random selection of 6,000 girls were exposed to different components of the intervention. Key results, noted in this brief, are: conditional cash transfers are a key driver of improvement in education outcomes, and of delaying sexual debut and pregnancy in …

The Adolescent Girls Initiative-Kenya—Executive Summary: Two-Year Follow Up Results, Population Council

Poverty, Gender, and Youth

In Kenya, early pregnancy is a challenge for girls that often has immediate effects on their educational opportunities, future implications for their social, health, and economic outcomes, and immediate and ongoing negative impacts on their children. Early pregnancy is an outcome shaped by a myriad of issues affecting an adolescent girl’s life—including community norms on gender roles, violence, and the social value of girls; barriers to formal education; household poverty; lack of economic independence; experience of violence; and social isolation. For girls to achieve well-being in early and late adolescence, no single-sector intervention—whether it be education, health, wealth creation, or …

Psychological Distress Prevalence And Associated Stressors And Supports Among Urban-Displaced Congolese Adults In Kenya, Julie A. Tippens, Holly Hatton-Bowers, Ryan Honomichl, Lorey Wheeler, Helen M. Miamidian, Kirstie L. Bash, Michelle C Howell Smith, Dulo Nyaoro, J. Joshua Byrd, Samuel E. Packard, Nicolette I. Teufel-Shone

Department of Child, Youth, and Family Studies: Faculty Publications

Background: There is limited understanding of the prevalence of psychological distress and associated stressors and supports among displaced adults in low- and middle-income first asylum countries.

Method: This article reports the findings of a cross-sectional study. We recruited 245 Congolese adults (18–80 years) residing in Nairobi, Kenya using snowball sampling. Data were collected using an interviewer-administered questionnaire consisting of sociodemographic characteristics, the Self-Reporting Questionnaire (SRQ-20), and a locally developed stressors and supports survey. We used multivariable logistic regression to examine associations among sociodemographic, stressor, and support variables and the likelihood of experiencing psychological distress.

Results: More than half of the …

Commentary: Using Law More Effectively Towards Abandonment Of Fgm/C In Kenya, Agnes K. Meroka-Mutua

Reproductive Health

Female genital mutilation/cutting (FGM/C) is considered a harmful cultural practice and a form of violence against women. Kenya has an FGM/C prevalence rate of 21 percent, but levels vary by ethnic group. Kenya has adopted a robust legal framework for the prohibition of FGM/C, including passage of the Prohibition of FGM Act in 2011, a detailed law that criminalizes carrying out FGM/C and associated offenses. Kenya relies on the human rights–based approach and criminalization in its legal framework for the prohibition of this practice. Despite extensive legal provisions, Kenya has prosecuted fewer than 100 cases, raising concerns with the law’s …

Lessons From A Five-Year Research Programme On Fgm/C And Their Relevance For Policy And Programmes In Kenya, Dennis Matanda, Agnes K. Meroka-Mutua, Samuel Kimani

Reproductive Health

The Sustainable Development Goals target the elimination of all forms of harmful practices, including female genital mutilation/cutting (FGM/C) by 2030. Kenya has made progress in addressing the elimination of FGM/C through ratification of global instruments and enactment of the Prohibition of FGM Act in 2011 and other supportive laws. The Act created the foundation for the establishment of the Anti-FGM Board, which provides policy leadership and coordination of anti-FGM/C programs in Kenya. More recently, the President of Kenya issued a decree for accelerated elimination of FGM/C by 2022. This synthesis report highlights how evidence generated over the last five years …

Female Genital Mutilation/Cutting: A Review Of Laws And Policies In Kenya And Nigeria, Samuel Kimani, Otibho Obianwu

Reproductive Health

Female genital mutilation/cutting (FGM/C) is a cultural practice that has health and human rights impacts on girls and women. The health sector has responsibility for prevention and response to provision of care services to women/girls with FGM/C-related complications. The mandate for the health sector response to FGM/C is anchored in nationwide or sector-specific legal/policy instruments. Kenya and Nigeria have ratified global legal/policy instruments and adopted WHO guidelines/tools for the prevention and management of FGM/C. The extent to which existing legal/policy documents in these two countries address prevention and response to management of FGM/C has been unclear. A desk review was …

Appendices—Female Genital Mutilation/Cutting: A Review Of Laws And Policies In Kenya And Nigeria, Samuel Kimani, Otibho Obianwu

Reproductive Health

This document contains Appendices to “Female Genital Mutilation/Cutting: A Review of Laws and Policies in Kenya and Nigeria.” Appendix 1 contains two tables: “Components of Kenyan Laws Related to FGM/C Prevention and Management,” and “Components of Nigerian Laws Related to FGM/C Prevention and Management.” Appendix 2 contains seven tables: “Components Relevant to Health Sector Response to Prevention and Management of FGM/C in Kenyan Policies,” “Components Relevant to Health Sector Response to Prevention and Management of FGM/C in Nigerian Policies,” “Components Relevant to Health Sector Response to Prevention and Management of FGM/C in the Kenyan Plans of Action,” “Components Relevant to …

Implementation Process Brief: Integrated Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Charlotte E. Warren, Aparna Jain, Melsa Lutomia, Jane Loech, Elizabeth Washika

Reproductive Health

Enabling women living with HIV to use contraception effectively can decrease unintended pregnancies and in turn reduce maternal mortality and vertical transmission of HIV. This brief describes the implementation process and intervention tested under the Evidence Project for delivering integrated FP and HIV services at the community level in Kenya. It outlines the implementation steps, best practices, and lessons learned of an intervention that was tested within the existing community health structure. Community health volunteers were trained to offer FP as part of their routine services to women living with HIV, and community health units were prepared to sustain those …

A Diagnostic Assessment Of The Health System's Response To Female Genital Mutilation/Cutting Management And Prevention In Kenya: A Case Study Of West Pokot County, Samuel Kimani

Reproductive Health

Female genital mutilation/cutting (FGM/C), a pervasive cultural practice in some contexts, is associated with negative impacts on women’s and girls’ health and rights. The health sector is well positioned to respond to the prevention of FGM/C and the management of its complications because of its primary role in disease prevention, health promotion, and curative services. In Kenya, the health sector’s role is anchored in national and county legal and policy instruments and guidelines that are adopted or customized from global or regional frameworks as well as skills support tools approved by the World Health Organization. This brief highlights findings from …

Understanding Local Variation In How Female Genital Mutilation/Cutting Declines, Changes, Or Persists: Analysis Of Household Survey Data For Kenya, Nigeria, And Senegal, Population Reference Bureau

Reproductive Health

Efforts to eliminate female genital mutilation/cutting (FGM/C) intensified in many parts of Africa following a 2012 United Nations General Assembly Resolution, but change has been uneven. Important evidence gaps remain in our understanding of why the practice declines, changes, or persists in specific locations. Policymakers and program planners need such information to better tailor interventions to address local patterns and focus resources on abandonment efforts in areas with the greatest needs. To fill these gaps, researchers with the Evidence to End FGM/C consortium analyzed nationally representative household survey data for Kenya, Nigeria, and Senegal. The results of their research identify …

Urban Congolese Refugees’ Social Capital And Community Resilience During A Period Of Political Violence In Kenya: A Qualitative Study, Julie A. Tippens

Department of Child, Youth, and Family Studies: Faculty Publications

Community resilience has been used as a conceptual framework to promote urban refugee protection, integration, and well-being. In the context of this focus on “refugee communities,” it is critical to gain a deeper understanding of the ways urban refugee “communities” function. This study explored urban Congolese refugees’ use of social capital to promote resilience during a period of political violence in Nairobi, Kenya. Findings illustrate how refugees used social capital across different contexts to access and distribute resilience-promoting resources. Women primarily relied on informal bonding forms of capital while men exhibited greater degrees of access to formal bridging and linking …

Tracing Change In Female Genital Mutilation/Cutting: Shifting Norms And Practices Among Communities In Narok And Kisii Counties, Kenya—Brief, Dennis Matanda, Chantalle Okondo, Caroline W. Kabiru, Bettina Shell-Duncan

Reproductive Health

This policy brief summarizes key findings from a study that examined whether there are shifts in norms and practices related to FGM/C among communities in Narok (predominantly inhabited by Maasai) and Kisii (predominantly inhabited by Abagusii) counties in Kenya. Although Kisii and Narok are FGM/C hotspots, practicing communities in these counties are reassessing norms and traditions in light of the current social and legal climate. These changes may provide a useful starting point for intervention programs that seek to create dialogue and critical reflection on the practice of FGM/C in an effort to accelerate its abandonment. Programmatic recommendations include: engaging …

The Medicalisation Of Female Genital Mutilation/Cutting In Kenya: Perspectives Of Families And Health Care Providers, Population Council

Reproductive Health

This evidence brief summarizes key findings from a study that sought to understand the shifts in FGM/C including medicalization among several communities Kenya. The study finds that medicalization is increasing because: 1) it is perceived to be safer because the procedure is reportedly performed under sterile conditions by trained health professionals; 2) it is believed to shorten the recovery period; and 3) it is a response to the law prohibiting the practice because it allows FGM/C to be performed in secret. These findings indicate that medicalization is an adaptation to awareness of the health complications associated with FGM/C and the …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Kenya, Charlotte E. Warren, Pooja Sripad, Charity Ndwiga

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In …

Using Demographic And Health Surveys In The Campaign To End Fgm/C: A Kenyan Example, Dennis Matanda, Caroline W. Kabiru

Reproductive Health

In order to design effective interventions to end female genital mutilation/cutting (FGM/C), we need to map where FGM/C is practiced and what factors influence it. Data from the Demographic and Health Surveys (DHS), nationally representative surveys conducted in low- and middle-income countries every five years, give us the opportunity to explore how FGM/C is influenced by both individual and community-level factors. Where FGM/C prevalence is not uniform, various research and analysis techniques can be used to improve estimates and draw further information from DHS data. This brief shares insights from two studies carried out in Kenya using DHS data collected …

Associations Between Fgm/C And Hiv In Ethiopia, The Gambia, Kenya, And Sierra Leone: A Limited Analysis Of Demographic And Health Survey Data, Yetunde A. Noah Pinheiro, Zhuzhi Moore, David Gathara

Reproductive Health

Studies investigating the association between male circumcision and HIV have demonstrated the protective effect of male circumcision. In some settings, FGM/C and male circumcision are considered “equivalent” procedures. This working paper presents findings of a study that investigates the effect of FGM/C on the likelihood of HIV infection for women in practicing communities in Ethiopia, Gambia, Kenya, and Sierra Leone.

Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance

Reproductive Health

The goal of family planning and reproductive health operations research is to generate evidence that helps policies and programs maximize access to and quality of services for women and their families. Yet the crucial step of ensuring the utilization of that evidence often receives inconsistent or inadequate attention. The goal of this case study is to document an activity of Marie Stopes International (MSI) in Kenya, part of the STEP UP research program consortium, which resulted in successful evidence utilization. STEP UP research on quality of care for medical abortion, particularly on pharmacy provision of medical abortion, has provided the …

Addressing Barriers To Quality Of Underutilized Commodities And Services For Prevention And Management Of Pre-Eclampsia And Eclampsia In Kenya, Charity Ndwiga, Pooja Sripad, Charlotte E. Warren

Reproductive Health

The Ending Eclampsia Project seeks to increase access to quality, underutilized interventions and commodities for the prevention, detection, and management of pre-eclampsia and eclampsia (PE/E), including promoting correct use of antihypertensive drugs and magnesium sulphate (MgSO4). This final report details the findings of a qualitative study that explored health system bottlenecks that prevent access to quality maternal and newborn health care in two Kenyan counties, Kakamega and Kitui, with a specific focus on PE/E. The study explored policy implementation gaps in Kenya’s newly devolved county government structure, to:1) assess the policy and health system environment for PE/E diagnosis, referral, and …

Retrospective Cohort Study: Clinical Presentation And Outcomes Of Pre-Eclampsia And Eclampsia At Kenyatta National Hospital, Nairobi, Kenya, Charity Ndwiga, Alfred Osoti, Pooja Sripad, George Odwe, Omondi Ogutu, Charlotte E. Warren

Reproductive Health

Pre-eclampsia has two distinct subtypes: early onset pre-eclampsia, which occurs before 34 weeks of gestation, and late onset pre-eclampsia, which occurs after 34 weeks. Few studies examine and compare early and late onset pre-eclampsia in a low- and middle-income country setting. This study’s goal was to establish a profile of patients with hypertensive disorders in pregnancy, especially pre-eclampsia and eclampsia, over a two-year period. At Kenya’s national referral hospital, clinical presentation at admission was examined, as was management of complications, along with maternal and newborn health outcomes in the hospital’s maternity unit, to ascertain any differences in health outcomes for …

What Works To Improve Outcomes For Kenya's Adolescent Girls?, Population Council

Poverty, Gender, and Youth

This fact sheet outlines results from the Adolescent Girls Initiative–Kenya, a study that evaluates the long-term impact of a multi-sectoral intervention targeted at adolescent girls aged 11 to 15 years from Kibera and rural Wajir. The intervention consists of four different components: a community-based violence-prevention program, an education conditional cash transfer (CCT), health-focused girls' empowerment clubs, and wealth creation for girls via financial education and savings. Results indicate that the approach was a cost-effective way to create positive change across a range of well-being factors for young adolescent girls, including education, health, and economic outcomes.

Expanding The Evidence Base And Networks For Sexual Violence Response In East And Southern Africa—Completion Report For The Period May 2014–February 2018, Population Council

Reproductive Health

This is the final report of the Expanding the Evidence Base and Networks for Sexual Violence Response program, which, over the years, has enabled regional partners to collectively test and document experiences in tackling violence against children and sexual and gender-based violence (SGBV) in humanitarian contexts. To foster SGBV prevention and ensure that responses to SGBV are effective, the program has targeted a range of stakeholders, including influential regional bodies; the health, education, and justice sectors; and children and refugees—as survivors as well as members of communities where prevention is being promoted. The program has helped to change the way …

Shifts In Female Genital Mutilation/Cutting In Kenya: Perspectives Of Families And Health Care Providers, Samuel Kimani, Caroline W. Kabiru

Reproductive Health

Despite compelling reasons and efforts to eradicate female genital mutilation/cutting (FGM/C) in Kenya, the practice has persisted, albeit with some changes. This study sought to understand the shifts in FGM/C among families and healthcare providers from selected Kenyan communities that practice FGM/C. Our findings highlight similarities and differences across three distinct Kenyan communities. FGM/C appears to persist through two models: first, shifts (changes) in the practice, notably cutting at a younger age, lesser cutting; and second, through stability and consistency with minimal change. The two diverse models appear to rely on and sustain social norms that support FGM/C in these …

Strengthening The Integration Of Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Brian Mdawida, Charlotte E. Warren, Melsa Lutomia, Jane Koech, Elizabeth Washika, Aparna Jain

Reproductive Health

Study findings reveal that many Kenyan women living with HIV are comfortable receiving family planning (FP) services from community health volunteers and with proper training and support, community health volunteers have the potential to provide integrated FP/HIV services. Community-based integrated FP/HIV services could help connect women living with HIV who want to prevent or postpone a pregnancy to contraceptive services, which can reduce unintended pregnancies and in turn maternal mortality and vertical transmission of HIV. This implementation research study offers evidence of the feasibility, quality of care, and acceptability of using community health volunteers to integrate family planning into HIV/AIDS …

Tracing Change In Female Genital Mutilation/Cutting: Shifting Norms And Practices Among Communities In Narok And Kisii Counties, Kenya, Dennis Matanda, Chantalle Okondo, Caroline W. Kabiru, Bettina Shell-Duncan

Reproductive Health

In Kenya, there has been a steady and marked decline in the prevalence of female genital mutilation/cutting (FGM/C) but there is great variance in the prevalence of FGM/C across the country, with prevalence remaining high among certain ethnic groups such as Somali, Samburu, Kisii, and the Maasai. The objectives of this study were: 1) to explore whether and how unprogrammed factors or programmed FGM/C interventions (alternative rites of passage, legal and policy measures, religious-oriented approaches, promotion of girls’ education, intergenerational dialogues, use of rescue centers, and other undocumented approaches) influence community values deliberation in Narok and Kisii counties; 2) to …

What Do We Know About The Hiv Risk Characteristics Of Adolescent Girls And Young Women In Kenya? Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

The Population Council is conducting implementation science research in Kenya to build needed evidence to inform community-based, girl-centered interventions. DREAMS programs in Kenya are implementing a core package of interventions in the highest HIV-burden areas to address HIV risk among adolescent girls and young women (AGYW)—a population in which AIDS is the leading cause of death in the region. This brief summarizes key findings from a survey of 1,778 AGYW, more than half of whom are enrolled in DREAMS programming.

Nisitu (Nisikilize Tujengane): Listen To Me, Let’S Grow Together, Population Council

Poverty, Gender, and Youth

Evidence from several studies, including in Kenya, supports the idea that empowerment and asset-building interventions targeting multiple levels of the socio-ecological environment can improve education, health, economic and social capital, gender-equitable attitudes, and violence outcomes for girls. This brief describes efforts by researchers to test the effects of engaging boys and men alongside girl-centered programming to improve the lives of adolescent girls. In 2017, the Population Council and partners undertook formative research to understand from girls: 1) what are the most influential types of males in their lives; 2) how and what they influence; and 3) what behavior changes among …

Assessment Of Comprehensive Hiv-Risk Reduction Programming For Adolescent Girls And Young Women: Implementation Science Research In Kenya, Population Council

HIV and AIDS

The Population Council is conducting implementation research to build needed evidence to inform decisionmaking around effective implementation of community-based, girl-centered interventions and to assess their effectiveness in reducing HIV vulnerability among adolescent girls and young women (AGYW)—a population in which AIDS is the leading cause of death in the region. Learnings from this study in Kenya and similar ones in Zambia and Malawi will be valuable for informing each country and the region how to implement AGYW programming that goes beyond the health sector to reduce AGYW’s vulnerability to HIV.

Modeling And Mapping Of Girls' Female Genital Mutilation/Cutting (Fgm/C) In The Context Of Economic, Social, And Regional Disparities: Kenya Demographic And Health Surveys 1998-2014, Ngianga-Bakwin Kandala, Damaris Kinyoki, Ahmed Sarki, David Gathara, Paul Komba, Bettina Shell-Duncan

Reproductive Health

The aim of this research study is analysis of successive household data for estimating and revealing trends, similarities, and differences in geographic patterns for the burden of female genital mutilation/cutting (FGM/C) and related risk factors among girls ages 14 and younger in Kenya. This Evidence to End FGM/C study, from a coalition led by the Population Council, is intended to contribute to a deeper understanding of the recent burden of FGM/C among the girls within this very young age group, and to enhance knowledge of the geographic distribution of this practice over time. The report will inform current elimination efforts …