(Hold) Barriers to care: How systemic failures endanger teenage mothers in Kenya

The prevalence of teenage pregnancies among adolescents is high. (Photo: Freepik)

By Charity Kilei
Thursday, September 4, 2025

In June, I visited one of Nairobi’s informal settlements after The Eastleigh Voice received a distress call about Vivian*, an expectant 17-year-old who was homeless and stranded.

We found Vivian squatting at a friend’s house, having been chased away from her grandmother’s home. As we spoke outside the modest home, which she now relied on for shelter, her face was etched with fear, confusion, and deep uncertainty. While blame had been passed around, it paled in comparison to the overwhelming anxiety she felt about her future and the imminent birth of her child.

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Under the Social Health Authority (SHA), teenage mothers are entitled to support through a streamlined system, including a temporary ID or unique identifier to access care. But instead, she had been bounced from one point to another.

The system required a national ID, which she didn’t have. And although she had a birth certificate, it wasn’t accepted. Everyone she turned to, from community health promoters to local health facilities, was either unaware of the process or unable to assist, leaving her trapped in a cycle of confusion, neglect, and despair.

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While some teenage mothers have benefited from Kenya’s social health support systems, many others continue to face serious risks due to systemic barriers. The SHA, though well-intentioned, often fails to account for the complex realities faced on the ground.

Many caregivers and health workers lack adequate training or clear guidance on how to enrol teenage mothers. As a result, access to timely antenatal care is delayed or denied, putting young mothers at even greater risk.

One such case is that of Vivian (name changed for privacy), the 17-year-old I met in June. Pregnant and without family support following the death of her grandmother, Vivian had been turned away from multiple health facilities due to lack of a national ID. With no legal guardian to speak on her behalf, her situation became increasingly desperate. She had already missed several antenatal appointments, and with nowhere to go and no one to advocate for her, access to care became nearly impossible—unless someone stepped in to insist she be treated.

That someone was Lizzy, a local Community Health Promoter (CHP), who had reached out to The Eastleigh Voice for help. Despite her tireless efforts, Lizzy could not get Vivian enrolled into the system or receive the care she needed—until her story was highlighted publicly.

Following that, The Eastleigh Voice reached out to the Social Health Authority—and fortunately, we received a positive response. The case was urgently handled. Vivian was transported to Pumwani Maternity Hospital by ambulance, a service also covered as part of the emergency intervention. She was admitted and received the care she needed. An OTP (one-time password) was sent to Lizzy’s phone, temporarily recognizing her as the acting guardian. Although the treatment cost KES 11,000, only KES 400 was paid out of pocket—the rest, including the ambulance, was fully waived.

Vivian successfully delivered her baby and was discharged safely.

In the days that followed, The Eastleigh Voice learned that Vivian’s paternal relatives had been located and had taken her and the baby in. However, the challenges did not end there.

Three months later, Vivian continues to face significant barriers. After relocating, she now struggles to access care in her new area, as local dispensaries remain unwilling to help without formal identification. Lizzy explains that, due to recurring obstacles, some CHPs have begun tracing the fathers of teen mothers in order to register the girls or their children as dependents under SHA—just to unlock access to care.

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“What I know is how to register someone under Form *147 and follow up. But when it comes to teen mothers, neither I nor my colleagues know the proper process,” Lizzy admits.

This lack of clarity is not unique to Vivian’s case. In Kamukunji, Joy, another Community Health Promoter (CHP), has also encountered several cases of expectant teenage mothers being turned away from health facilities due to lack of identification. Just this month, she says, multiple girls were denied care for not being enrolled in the SHA system. Despite repeatedly coming to her for help, Joy explains that even when she refers them to facilities, they still face hurdles—either being told to wait, being ignored, or receiving vague promises like “we’ll check.”

"Personally, I don’t know how to register people properly—especially teen mothers," Joy admits. "When they come to me for help and I refer them to a facility, they’re often turned back. It’s very discouraging, especially for those who have no money to walk from one clinic to another."

The result is a growing sense of hopelessness among these girls, many of whom eventually give up seeking care altogether—putting both their lives and their babies at risk.

“Some of these teens, when asked for documents they don’t have, simply stop going to the clinic altogether—putting their lives and their babies at risk,” she says.

These are not isolated incidents. In another case, a pregnant orphan living in a safe house faces a similarly painful and precarious situation as she approaches delivery. Without any documentation and with no clear pathway to care, she faces immense challenges in accessing the support she desperately needs. Now, she is seeking her birth certificate through relatives—an emotionally fraught process that can reopen wounds, especially when family members are unsupportive or unwilling to help.

The system offers no clear provisions to protect young mothers in such vulnerable circumstances. Some Community Health Promoters (CHPs) even warn of the increased risk of home births or unsafe abortions, as the current system no longer favors timely and accessible care for these young women.

In cases where a birth certificate is available, some teens do manage to access services—especially when referred to major hospitals. But at the grassroots level, the situation remains dire. Care is frequently delayed or denied altogether. Many young mothers are forced to navigate pregnancy alone; without the essential support they need and deserve.

A spot check with several Community Health Promoters in grassroots informal settlements revealed that many are unsure how to properly onboard teenage mothers into the system.

The Ministry of Health launched a temporary unique ID system for teenage mothers, but at the grassroots levels—levels 1, 2, and 3—many young mothers still face significant hurdles. Most community health workers are unclear about where to direct these teens, often forcing them to seek care at level 4 or 5 facilities, which are usually far from their neighborhoods. This distance causes dangerous delays in treatment. Many Community Health Promoters simply provide the teen’s birth certificate, but in cases where no documentation exists, care is often denied altogether. This situation raises critical questions about how indigent or undocumented teenage mothers can be identified and properly supported within the system.

Teenage pregnancy remains a significant challenge in Kenya, with about 15percent of girls aged 15 to 19 having experienced pregnancy, according to the 2022 Kenya Demographic and Health Survey. The likelihood of pregnancy increases with age during adolescence, rising from around 3percent at age 15 to over 30percent by age 19. Teenage pregnancy rates are higher in rural areas (16 percent) compared to urban centers (12 percent ), and are more prevalent among girls with little or no education and those from lower-income households.

The situation is often even more severe in informal settlements within urban areas, where poverty, limited access to healthcare, overcrowding, and inadequate sexual and reproductive health education compound the risks. In these communities, young girls frequently face barriers to accessing maternal care and support services, increasing their vulnerability to early pregnancies and poor health outcomes.