Reproductive Oppression and Reproductive Autonomy of Girls and Young Women in Kenya

Girls and young women’s reproductive autonomy – their rights, their choice, and the enabling conditions for them to freely and autonomously have children, not have children, and raise them in safe, sustainable communities – is under constant threat. They endure entrenched reproductive oppression: violence, exploitation, and control over their bodies, sexuality, and reproduction, alongside disproportionately adverse reproductive health outcomes, such as high rates of unintended and unwanted pregnancies, unsafe abortions, and unmet contraceptive needs. Their reproductive decision-making is often dictated by intimate partners and family members, whilst their access to and use of contraception and family planning services is restricted by health system legislation and protocols, clinic infrastructure, and harmful social, cultural, and religious norms. These obstructions are especially stark in low- and middle-income countries and high-fertility settings, where intense pressure around childbearing further inhibits girls and young women’s reproductive autonomy. Despite these barriers, girls and young women actively assert their reproductive autonomy, employing strategic approaches to access and use family planning clinic services and contraceptive methods. They discreetly obtain and conceal contraceptives, work during school breaks to afford services, and leave unsupportive partners. Sometimes, they are supported by key allies. However, the structural, systemic, and social forces influencing girls and young women’s reproductive lives – and the requisites for their reproductive autonomy – remain severely under-researched and seldom addressed in policy and practice. This thesis explores the realities of reproductive oppression and the conditions that shape reproductive autonomy for girls and young women (aged 15-19 years) in Uasin Gishu County, Kenya. Based on qualitative research conducted in county government-run family planning clinics from 2021 to 2024, it captures the experiences of 77 girls and young women, 27 clinic providers, and 47 key stakeholders. Using in-depth interviews, focus group discussions, and a stakeholder workshop, this study applied an intersectional, positive rights-based reproductive justice lens and used both inductive and deductive reflexive thematic analysis. Results are presented across four interconnected research papers. Reproductive oppression of girls and young women manifested as violence, exploitation, control, harassment, neglect, forced contraception, and coerced abortion. It was built-into laws, policies, and procedures regulating access to contraception and abortion, enforced by providers and teachers, and justified by social, cultural, and religious beliefs. It also served those who wielded it, granting them personal or professional advantage. Yet, girls and young women also exercised agency, resisting obstructions to their reproductive autonomy – sometimes with the support of key allies, such as their sisters and friends. Their narratives revealed reproductive autonomy’s enabling conditions: safe, private, and confidential family planning clinics; dignified, respectful health care; clear, tailored sexual and reproductive health information; and strong support networks. Interviewees’ narratives exposed the tension between reproductive oppression and autonomy, highlighting their profound impact on girls and young women’s reproductive decision-making, health, and overall lives. For instance, menstrual bleeding – an unavoidable biological reality – emerged as a significant threat to reproductive autonomy. Mediated by menstrual surveillance, menstrual and contraceptive stigma, and period poverty, menstruation was wielded as a tool of reproductive oppression, intersecting with gender-based violence in harmful and far-reaching ways. These findings can inform future research, particularly by integrating qualitative insights from girls and young women’s family planning experiences into quantitative measurement tools. This includes developing scales that capture the complexity of their reproductive intentions, agency, resistance, and the influence of structural forces, key institutions, and contraceptive gatekeepers. This thesis also presents policy and practice recommendations, underscoring its relevance for sexual and reproductive health policies, clinical practice, adolescent health programs, gender-based violence prevention and response, and menstrual hygiene initiatives.