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Admin In Mukuru, Nairobi, conversations about adolescent sexual and reproductive health can be difficult to have at home, in schools and even in healthcare settings. For some young people, fear of judgment, punishment or rejection makes it harder to ask questions, seek medical advice or disclose a pregnancy. In some cases, the consequences of that silence can be life-threatening.
Mary (not her real name) a young woman from Mukuru experienced this after procuring an abortion. Afraid of her parents’ reaction, particularly her strict father, she tried to conceal what had happened. She later experienced excessive bleeding, her condition deteriorated, and she eventually ended up in hospital. She nearly lost her life.
Another young woman, Caroline (not her real name) recounted losing a friend in a suspected pregnancy termination case. According to her account, the friend had received pills brought to her by another friend. She died before reaching hospital. The circumstances surrounding her death have not been independently established, and the account does not establish the cause of death.
Both young women requested anonymity to protect their privacy. Their experiences reveal the potentially devastating consequences when fear and stigma discourage adolescents from seeking reliable information and timely medical care.
What the numbers reveal
The experiences emerge against a broader national and county-level reproductive health picture.
According to the 2022 Kenya Demographic and Health Survey (KDHS), 14.8% of girls and young women aged 15–19 in Kenya had ever been pregnant. In Nairobi City County, the comparable figure was 8.4%. Although Nairobi’s estimate was below the national average, it shows that adolescent pregnancy remains a concern in the capital
The same survey data indicate that Nairobi recorded an estimated 57 live births per 1,000 women aged 15–19 in 2022, compared with 73 nationally.
These figures describe adolescents across Nairobi County, not specifically those living in Mukuru kwa Ruben or Mukuru kwa Njenga. They also do not measure how many adolescents experience unsafe abortions or delay seeking care because of stigma. Nevertheless, they provide important context for understanding the reproductive health challenges facing young people.
When conversations become taboo
Adolescence is a period of physical, emotional and social change. Young people need reliable information about their bodies, relationships, consent, contraception and sexually transmitted infections. Yet these conversations are often surrounded by shame, cultural expectations and fear of being labelled irresponsible.
Maureen Ogutu, a Nurse and Safeguarding Officer at Ruben Health Centre, says adolescents commonly seek help for concerns including unintended pregnancies, sexually transmitted infections, HIV/AIDS, sexual and gender-based violence, menstrual health challenges and limited access to contraceptives.
In Mukuru, fear of parental judgment and the stigma surrounding adolescent sexuality can push young women into desperate situations. One survived severe bleeding after an abortion she tried to conceal from her strict father. Another is mourning a friend who died after reportedly taking abortion pills obtained through a friend. Their experiences reveal the potentially devastating cost of silence.
Some adolescents lack adequate information about contraception, condom use, HIV prevention, consent and healthy relationships. Others depend on peers or social media, where information may be incomplete or misleading.
“There is a need for more age-appropriate sexual health education and accessible, youth-friendly healthcare services,” Ogutu says.
She notes that shame and fear can prevent adolescents from asking questions or seeking medical assistance. When parents and guardians respond with anger or punishment rather than guidance, young people may hide their circumstances until they need urgent help.
Creating space for honest conversations does not mean encouraging risky behaviour. It means ensuring adolescents can access accurate information and seek support without unnecessary humiliation.
The consequences of delayed care
Stigma can affect adolescents’ emotional well-being, self-esteem and relationships. Some experience anxiety and isolation, while others conceal pregnancies or avoid health facilities because they fear being exposed.
For a pregnant adolescent, the consequences may extend beyond health. Pregnancy can interrupt education and create financial and social difficulties, particularly where a young person depends on family members or a partner for support.
“Fear and stigma may cause the adolescent to hide her pregnancy or delay seeking antenatal care,” Ogutu explains. “Financial dependence and lack of family support may make her vulnerable to pressure from a partner or other individuals.”
The young woman who experienced excessive bleeding in Mukuru said fear of her father’s reaction contributed to her decision to hide what had happened. Her experience raises an important question: how many young people delay seeking help because they fear the consequences of telling an adult?
Unsafe practices and the need for reliable care
Abortion remains a particularly sensitive subject in many Kenyan communities. Fear of judgment, exposure and possible legal consequences can discourage adolescents from seeking reliable medical information or professional care.
Ogutu warns that stigma may push some young people towards unsafe practices.
“When adolescents fear stigma or legal consequences, they may seek assistance from unqualified providers or use dangerous methods that can cause severe bleeding, infection, injury, infertility, or death,” she says.
Kenya’s Constitution restricts abortion, with exceptions provided under Article 26(4). Given the legal and medical complexities, adolescents should seek accurate guidance from qualified healthcare professionals rather than rely on rumours, unverified online advice or informal recommendations.
The two accounts from Mukuru underline the importance of accessible, trustworthy health services. They also demonstrate why suspected cases must be reported responsibly: the circumstances of a pregnancy termination and the cause of a death should not be presented as medically established without reliable evidence.
Post-abortion care can save lives
Whatever the circumstances surrounding a pregnancy loss or abortion, complications require prompt medical attention. Fear of judgment should never prevent someone from seeking emergency treatment.
Ogutu says adolescents may conceal symptoms or delay visiting a health facility because they fear exposure, blame or legal consequences. Such delays can lead to severe blood loss, infection, shock and, in some cases, death.
Warning signs requiring urgent medical assessment include severe bleeding, fainting, intense abdominal pain, fever and foul-smelling vaginal discharge following an abortion or miscarriage.
Healthcare providers can help by offering timely treatment, respectful care, appropriate referrals and private consultations. Protecting patient information, within applicable legal and safeguarding requirements, can also help young people feel safer seeking assistance.
Replacing silence with support
Addressing stigma requires action from families, schools, healthcare providers and community leaders.
Parents and guardians can create safer spaces for young people to ask questions about consent, relationships and sexual health without immediately facing punishment or humiliation. Schools and community organisations can strengthen age-appropriate education, while health facilities can provide youth-friendly services, counselling and reliable referrals.
Nairobi County’s own reproductive health priorities include expanding access to contraception and strengthening community-level services. In a 2024 county statement discussing KDHS 2022 findings, officials reported an unmet need for family planning of 13%. This reinforces the importance of making reproductive health information and services accessible to those who need them.
The stories shared by the two young women from Mukuru are painful reminders of what can happen when fear overrides the search for help. Their accounts should not be used to shame adolescents, but to encourage compassionate conversations and stronger support systems.
Ultimately, reducing the cost of silence begins with listening. Adolescents need trusted adults, accurate information and healthcare services where they can seek assistance with dignity. When communities replace judgment with understanding, young people are more likely to speak up, seek care early and make informed decisions about their health.
By Bosco Christopher Kathima
