The last few weeks have seen Senator Susan Kihika come under fire for sponsoring the reproductive healthcare bill 2019.
This bill has struggled through Parliament since 2014, when it was first sponsored by Senator Judith Sijeny. The question remains, can we get past our differences and complete this process once and for all?
For us to make headway, it is important to acknowledge that no act of Parliament can supersede the supreme law of the land. And in matters regarding the right to health, the Constitution has been clear. In the same Constitution, the right to reproductive health is even further emphasised.
It is, therefore, important for us to unravel the core of reproductive health. In our cultural setting, matters regarding reproductive health have always been regarded as intimate and private as they are inexorably linked to sexuality. Information and knowledge regarding matters of reproduction have always been passed on from generation to generation behind closed doors, in hushed tones, with strict gender compartmentalisation.
For this reason, even as we continue to make great strides in demystifying reproductive health issues such as safe motherhood, male involvement, contraceptives and family planning and even infertility, the undertones continue to haunt us. We are caught in a future we aspire to have and a past we are clinging to for familiarity.
It, therefore, helps to first delink the term reproductive health and sex. This has to be done both literally and figuratively. We must look at this very core pillar of health for what it is, that the human body possesses a fully functioning system that is not only prone to illness, but also requires a lot of juice to run under normal circumstances because it carries heavy duty responsibility.
We must further acknowledge that part of its normal function requires involvement of another reproductive system from another individual in order to function. No other system does that. The heart beats throughout its normal lifespan without needing another heart to periodically beat with it. The lungs never need the neighbour’s pair to execute a synchronous respiration. These unique features make the reproductive system stand out and form the basis of a need for detailed regulation to address these unique characteristics.
Reproductive healthcare looks at the entire system, not bits and pieces as is currently fragmented for debate. The bill addresses adolescent health as an entry point into reproduction, as the active phase of the system. In the same manner babies are vaccinated to prevent future infections, is the same way adolescents must be prepared for what the next decades of reproductive life are going to look like.
For this to happen, appropriate information dissemination is necessary. Information regarding the function of the system, what can go wrong and how it should be appropriately addressed. Here we face the first challenge raised by a segment of the population. Are our children being exposed to too much information for their age? I prefer to look at it the other way round. Are we under-estimating the capacity of these children?
Less than half a century ago, many girls became mothers in adolescence. The very same parents concerned about the age issue were borne of adolescent moms, married off as teen brides, who went on to raise them into responsible adults that form the society today. They bore an average of seven children and ran their home with an iron fist, resulting in well-adjusted adults raising their own children today.
Did this come at a price? Of course it did. Many of these teen moms lost their lives bringing forth their babies at a tender age. Science has allowed us to understand that physically, one will fare better with the process of procreation at a slightly older age. This has advised regulation over the years, to outlaw early marriages and protect children from getting pregnant.
However, our young children did not become dumber mentally, if anything, they are probably smarter and more aware due to the environment they are growing up in. They are curious and will not stop until their curiosity is satisfied. So, we can choose to bury our heads in the sand or help them navigate the difficult phase with appropriate tools.
When we fail to provide guidance and protection, we end up with efficiently functioning systems that are powered by mother nature to go forth and fill the earth. It is worth noting that mother nature is completely unaware of the 18-year cut-off. She only functions on the basis of onset of ovulation. Until we learn to delay the onset of puberty to 18 years, we are faced with the reality that the preceding eight years remain a potential minefield.
We must never lose perspective that reproductive health in adolescents is more than teenage sex. The basket is full of other issues such as painful periods, hormonal imbalances, genital tract infections, anatomic abnormalities revealed in adolescence, genetic abnormalities and sexual abuse to name but a few. Let us not drown these by shouting only about sex.
In the same vein, we must remember doctors perform abortions regularly to save life and alleviate suffering. This has been happening even before it was prescribed in law. It is what the Hippocratic oath is all about. It is taught in medical school and it is not an easy decision.
In a world where the practice of medicine is shifting to a more patient-centred approach, we cannot expect the patient to be on the same page in their care if they have no guidance on the limits of the law. The bill is here to speak to the public about their health care realities. It is not creating any new provisions that are not already enshrined in the Constitution.
It is worth noting that this is a golden opportunity to protect those in society, for whom fertility is not their struggle, but rather infertility is. Those who did not have the luxury of any existing legislation to guide on how they can safely undergo assisted reproduction without further bearing the pain of financial and emotional exploitation and suffering. And in return, those with a heart large enough to help these struggling men and women, can do so without apprehension.
Maybe this is the time for all of us step back and allow Wanjiku to read the bill and make a decision on whether it serves her interest.
Dr Bosire is an obstetrician/gynaecologist