To be a girl in the Viwandani slum of Nairobi, Kenya, means sleeping in a one-room shack with as many as eight members of your family. It means convincing your parents that your monthly school fees are worth struggling to save for. It means scrounging for rags or old mattress stuffing to fashion a sanitary pad so you can go to school during that time of the month.
And for too many, it means ignorance about reproductive health.
I am a health care educator who has spent a decade working with women and families in the slums of Nairobi. When I meet with adolescents, as I did recently with a group of 75 in Viwandani, I talk about how to manage menstrual periods and the benefits of delaying pregnancy. On this particular visit, I was also there to deliver much-needed sanitary pads donated by girls' schools in the Baltimore-Washington area.
As I began talking with the girls, ages 11 to 15, they explained they already knew how to avoid getting pregnant. No, their strategies didn't involve abstaining from sex or using condoms. Here's what they said would prevent pregnancy: taking a hot bath, drinking hot water, jumping vigorously after sex, having sex in a standing position, or having sex when it is raining or in a swimming pool.
Their answers saddened me. But I probably shouldn't have been shocked. According to the 2014 Kenya Demographic Health Survey, the rate of contraceptive use is lowest among women ages 15 to 19, and 15 percent of them have already given birth.
These numbers have contributed to alarming rates of maternal mortality: Globally, complications related to pregnancy and childbirth are leading causes of death among girls ages 15 to 19.
When asked why they and their friends engage in sex at an early age, the girls explained their beliefs that sex reduces pains from their period and that a girl is able to dance well if she's had sex. They also mentioned hunger as a reason. When parents are not able to provide food or clothing, the girls can get these items from men in exchange for sex.
This is not just a Kenya problem.
This week, health leaders from around the world are meeting in Indonesia for the International Conference on Family Planning. One key part of the agenda is addressing youth reproductive health. As the program notes, there are more than 2 million adolescents with HIV, and one in 10 worldwide births is to a girl age 15 to 19.
Of course, many devoted people and organizations are already on a mission to address these issues.
But there are still girls out there, like the ones at my meeting in Nairobi, who don't even think of contraceptives as a way to prevent unwanted pregnancies. Once I told them about those options, however, they were receptive to them.
So there is still a need to better understand what drives pregnancy among adolescents and come up with targeted interventions.
One avenue of opportunity is in the classroom. When I meet with girls in Nairobi, I find they are hungry for the knowledge and skills that will lead to a bright future. The best way to achieve this is to prevent them from dropping out of school. Studies have shown that staying in school reduces the chances of girls getting pregnant or marrying early, lowers rates of HIV infection and puts them on track to acquire a career.
We also need parents, churches and other community structures to share reproductive health information with the adolescents. It's time that this education becomes part of the curriculum in schools globally.
That way, to be a girl in the Viwandani slum of Nairobi, Kenya, can mean earning a degree and going on to enjoy a productive life.
Jane Otai is an Aspen fellow and a community health educator working in Kenya for Jhpiego, an international health nonprofit organization and an affiliate of Johns Hopkins University.