access to emergency contraception by adolescents as a component of post rape care services in kenya
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1www.lvcthealth.org
Access to Emergency Contraception by Adolescents as a component of
Post Rape Care Services in Kenya
Obbayi, M; Nyaga, L; Digolo, L; Mbugua, C; Otiso,L
6th International Conference on Peer Education, Sexuality, HIV& AIDS
2014Dates: 16- 18 June 2014
Nairobi, Kenya
We have rebranded. We are now LVCT Health
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About LVCT Health
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• Formerly known as Liverpool VCT, Care and treatment.• An indigenous Kenyan non-governmental and non-
profit organization. • Founded in 1998 and registered in 2001• LVCT Health envisions healthy societies and uses
research results, capacity improvement and policy reform action for equitable HIV, SRH services to the most vulnerable populations.
• LVCT Health reached 1.3M Kenyans with HTC in 2013 with 80% linkage to care, 40,000 in care, 4300 survivors of sexual violence in 124 MOH facilities and 150,000 youthful callers to one2one hotline.
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Outline
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Background Access to comprehensive post rape care (PRC) Access to Emergency Contraception following
sexual violence Challenges Lessons Learnt Recommendations- Research, Policy, Practice Key messages
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LVCT Health
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Re- branded Indigenous organization Vision: Healthy Societies Mission: To use research, capacity
improvement and policy reforms action for equitable HIV, Sexual and Reproductive Health services to reach the most vulnerable.
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Background
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• One in five Kenyan women has experienced sexual violence (KDHS 2008-09); 32% SV incidents occur prior to Age 18 (Kenya Violence Against Children, VACS, 2010)
• Only 7.9% females age 13-17 report receiving health/ medical services following sexual violence.
• 30% females aged 18 to 24 who experienced sexual violence before the age of 18 got pregnant as a result.
• Of all rape- related pregnancies, 50% had abortion; 11.8% had spontaneous abortion (Holmes et.al, 1996)
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Background
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- Comprehensive Post Rape Care (PRC) services that should be delivered by the health sector include:- Injury management- HIV Post Exposure Prophylaxis (HIV PEP)- Pregnancy prevention- STI prophylaxis and treatment- Forensic examination and documentation- Counselling incl. Trauma, HIV test and PEP adherence
counselling- Referral to legal, justice and social services.
National guidelines on management of sexual violence in Kenya, 2009
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Comprehensive PRC services accessed
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Access to Emergency Contraception
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Access to Emergency Contraception
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• Up to 97% of children age 0-11 are excluded from ECP.• Possible late presentations.• Possible non- eligible children.• Possible general assumption of low or no risk of
pregnancy, even among pre- adolescents.• Data not able to disaggregate this.
Site 1 Site 2 Site 3 Site 4No. seen 52 11 40 25No. given ECP 3 1 0 0
Table showing number of survivors Age 0-11 receiving ECP over 7 months (N= 128)
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Challenges to access of ECP
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Health sector/ provider Community/ User Lack of clear guidance on
prescription of ECP in pre- adolescents
Limited capacity of health providers to deliver comprehensive PRC services
Periodic ECP stock outs Lack quality assurance
mechanisms for PRC services
PRC/ ECP data collection tools & reporting systems
Late presentation of survivors for care. [100% of survivors who missed ECP in Site 2 (March & April 2014) presented after 120 hours]
Non- presentation of survivors. [81% survivors did not seek services due to socio- cultural barriers (shame, ignorance, fear)-Kenya VACS, 2010]
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Lessons Learnt
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• Rape-related pregnancy occurs with significant frequency, but is grossly under-reported.
• Proper data collection and reporting systems can facilitate generation of data for decision making.
• Need for clear guidance on ECP prescription for pre- adolescents. This should not be left to the discretion of the provider.
• Community mobilization can be a key strategy for addressing socio- cultural barriers to service uptake thereby increasing demand for health services, including post rape care.
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Recommendations
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1. Research
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Community ECP? - Pregnancy prevention through community health resources e.g. Community Health Workers - Area of global interest - Need to generate local evidence on feasibility within local context.
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2. Policy
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- Develop and disseminate clear policies and guidelines on ECP prescription to children/ pre- adolescents.
- Resource allocation towards sustained and timely availability of ECP.
- Establish clear mechanisms for coordination and supervision of services.
- Establish clear data collection and reporting frameworks to inform decision making.
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3. Practice/ programming
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Health Facility:-Sensitization of providers on pregnancy prevention-Continuous provider training and mentorship.-Proper documentation and reporting. -Best practice sharing forums.
Community Mobilization:- Engagement of opinion leaders; male engagement- Social media- Adopt models that have worked e.g.
LVCT Health Online Integrated Digital Platform - Delivery of GBV/PRC through the Community Strategy.
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KEY Messages
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- ECPs prevent chances of pregnancy.
- ECPs may be beneficial up to 120 hours after rape. Pregnancy can therefore be prevented if you report to a hospital within 120 hours of rape.
- HIV and STIs can also be prevented if you report to a hospital within 72 hours of rape.
- It is not your fault that you were raped. Do not feel guilty. Do not be ashamed. Take action and report to the nearest hospital immediately!
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Thank YouCONTACT US:
[email protected]@lvcthealth.org
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