Kenyan NGOs fill mental health service gap for pregnant adolescents

Linet had just turned 19 when she realized that she was pregnant. She was fresh out of high school and unemployed. Linet’s boyfriend, who was the same age, asked her to get an abortion — but she chose to keep the baby.

She lives in Kibera, a large informal settlement in the Kenyan capital of Nairobi, with her mother and four siblings. To make a living, her mother cleans houses and does people’s laundry, among other odd jobs.

After giving birth, Linet — who asked that Devex withhold her surname to protect her privacy — was told that her baby had cerebral palsy. Her boyfriend ended their relationship shortly after the child was born. Being alone with an unplanned pregnancy and unable to provide for a newborn with a neurological condition took a toll on her mental health.

“I thought of committing suicide several times,” she said.

In Kenya, approximately 1 in 5 female adolescents aged 15-19 are either pregnant or already mothers. Though young people like Linet experience challenges such as depression, anxiety, and stress due to their pregnancies, research shows that they also face barriers to prenatal and mental health care in the country.

Kenya has fewer than 500 specialist mental health workers serving a population of over 50 million people. Now, community-based initiatives are being promoted to fill this gap for pregnant and parenting adolescents.

Manasi Kumar, a senior implementation scientist at Aga Khan University’s Brain and Mind Institute, led a study in Kenya finding that “Pregnant and parenting adolescents faced several adversities such as social stigma, lack of emotional support, poor healthcare access, and stresses around new life adjustments.”

These adversities put them at a greater risk of developing depressive symptoms, compared with adult women. This, coupled with low access to mental health care, creates a huge unmet need for mental health services.

In response, Kumar co-founded Tabasamu Café — an initiative, which gets funded by nonprofits, aimed at building awareness around mental health and supporting adolescent mothers in Nairobi. “Tabasamu” is the Swahili word for “smile,” and Kumar said the model is cost-efficient as it does not include hospitalizations or extensive treatment but instead uses simple interventions and community support.

“We use a design-thinking approach which likes to provide solutions to problems, which in our case is adolescent pregnancy, motherhood, and poor mental well-being,” she said.

Fidelis Wanjiku was 17 years old and in her final year of high school when she got pregnant. Born of a single mother, Wanjiku said that she felt like a burden to her family and that the pregnancy had cut short her academic ambitions.

“I had dreams and goals, but all were shattered when I got pregnant. I felt like a failure and had no use. I stayed in the house alone as my mother went to work,” she said.

After giving birth, Wanjiku said she didn’t know how to care for her child. “My mother would wash and change the baby in the morning and leave. She would then come back to change the baby in the evening. I didn’t know how to and didn’t want to,” she said.

Wanjiku received counseling as a parenting adolescent at Tabasamu.

“I used to see them at least twice a week when I went to the clinic in [a part of Nairobi known as] Kariobangi. There were many other girls there, and their stories made me feel I was better off. I healed, and now I speak to parenting adolescents too at Tabasamu,” she said.

Linet, meanwhile, had trouble dealing with the rejection of her boyfriend and the needs of her baby.

“I started working when my child was 3 months [old]. And since my child is disabled, I didn’t know how to take care of him or where to take him for therapy. I used to just sit in the house and cry. I was depressed,” she said.

Amid her struggles to care for the baby, a friend visited Linet and told her about Nivishe Foundation, an organization helping young mothers in Kibera.

The foundation, which was founded in 2019, says it has helped over 10,000 young people and over 4,000 women through its community-based mental health interventions.

Some adolescent mothers hear about Nivishe and then visit the organization of their own accord, while others are identified and approached by the foundation’s personnel.

“I always visit the schools in Kibera where it is easier to get the girls who are pregnant [to offer them help]. I also visit religious institutions. And once I make contact with them, I visit their homes to assess the situation and verify their ages,” said Lorine Atieno, a programs associate at Nivishe.

Atieno then seeks the consent of the girl and her parents or guardians to include her in the foundation’s program for teen mothers.

At Nivishe, the girls are offered individual and group therapy. They are also taught basic skills such as computer literacy and connected with other institutions that can train them in hairdressing, fashion and design, catering, and baking.

“At the end of the day, they need to support themselves because for many of them, their families are not responsible; they are on their own,” said Amisa Rashid, the founder and executive director of Nivishe Foundation.

Just like Nivishe, Tabasamu includes an empowerment component to train girls in entrepreneurial skills that can help them earn a living. After undergoing therapy and receiving training at Tabasamu, Wanjiku was able to start earning a living.

“I used to hawk boiled eggs in Kariobangi, and I managed to save enough to take me through a course in graphic design,” Wanjiku said. She has since stopped hawking boiled eggs and is now a volunteer at Tabasamu.

Nivishe and Tabasamu are key providers of counseling in their respective communities. Prior to Tabasamu’s launch, it was difficult to reach pregnant and parenting adolescents experiencing mental health issues unless they were referred for counseling by their schools, said Stephen Ochieng, the officer in charge at Pangani Dispensary, where Tabasamu is hosted.