World Health Organization, Department of Sexual and Reproductive Health and Research/Human Reproduction Programme, Geneva, Switzerland.
United Nations Children's Fund Office of Research, Florence, Italy.
Reprod Health. 2020 May 26;17(1):75. doi: 10.1186/s12978-020-00930-x.
BACKGROUND: The role of global initiatives in catalyzing change within national contexts is complex and less understood. Addressing adolescent sexual and reproductive health in Kenya requires concerted efforts of both state and non-state actors and more importantly, a supportive environment. This paper deconstructs the moral and social narratives of adolescents' and young people's sexual and reproductive health (AYSRH) in Kenya as driven by the powerful discourse and ideologies pre- and within the Millennium Development Goal (MDG) era. METHODS: Literature was systematically searched in PubMed and Medline with policy documents obtained from government agencies from the pre-MDG period (2000 and earlier) and within the MDG period (2001-2015). Literature with a substantial focus on SRH were eligible if they captured the different facets of ASRH in Kenya and sub-Saharan Africa (SSA). The results were reviewed and synthesized to disentangle the moral and social narratives of AYSRH in Kenya with an MDG lens. RESULTS: The evolution of AYSRH policies and programmes in Kenya was gradual and largely shaped by prevailing development threats and moral and social narratives. Pre-MDG period was dominated by issue-based policies of population growth and high fertility rates, with a focus on married population with strong cultural and religious barriers to AYSRH; early to mid-MDG was mainly influenced by the threat of HIV/AIDS, culminating in the first Adolescent Reproductive Health and Development Policy in 2003. However, the policies and subsequent programmes focused on abstinence only and medical narratives, with persistent religious and cultural opposition to AYSRH. Late-MDG saw more progressive policies (these are policies that refer to those that tends towards acceptance of liberal social reforms and which sometimes are contrary to entrenched social norms, beliefs and practices), high government commitment and a refocus on SRH issues due to sustained early childbearing, culminating in the revised Adolescent Sexual and Reproductive Health Policy of 2015. CONCLUSION: Debates in the translation of global goals and commitments to policy and practice at country level need to account for national level realities in AYSRH reforms. The findings contribute to critical evidence for strategic policy and programming approaches for AYSRH in Kenya and in SSA and for the realization of their rights within the context of sustainable development goals.
背景:全球倡议在国家背景下推动变革的作用复杂且理解不足。解决肯尼亚青少年性与生殖健康问题需要国家和非国家行为体的共同努力,更重要的是需要一个支持性的环境。本文剖析了在千年发展目标(MDG)前和 MDG 期间的有力话语和意识形态驱动下,肯尼亚青少年和年轻人性与生殖健康(AYSRH)的道德和社会叙事。
方法:在 PubMed 和 Medline 中系统地搜索文献,并从 MDG 前(2000 年及以前)和 MDG 期间(2001-2015 年)从政府机构获取政策文件。如果文献大量关注 SRH 并捕捉了肯尼亚和撒哈拉以南非洲(SSA)AYSRH 的不同方面,则符合入选标准。对结果进行了审查和综合,以从 MDG 视角剖析肯尼亚 AYSRH 的道德和社会叙事。
结果:肯尼亚 AYSRH 政策和方案的演变是渐进的,主要受当时流行的发展威胁和道德及社会叙事的影响。MDG 前时期以人口增长和高生育率为基础的问题导向政策为主,重点关注已婚人群,对 AYSRH 存在强烈的文化和宗教障碍;MDG 早期到中期主要受 HIV/AIDS 威胁的影响,最终于 2003 年出台了第一份青少年生殖健康与发展政策。然而,政策和随后的方案主要侧重于禁欲和医学叙事,对 AYSRH 存在持续的宗教和文化反对。MDG 后期出现了更多的进步政策(这些政策是指那些倾向于接受自由社会改革,有时与既定的社会规范、信仰和实践相悖的政策),由于持续的早育,政府高度承诺并重新关注生殖健康问题,最终于 2015 年修订了青少年性与生殖健康政策。
结论:在将全球目标和承诺转化为国家一级的政策和实践时,需要考虑到 AYSRH 改革的国家一级现实。这些发现为肯尼亚和 SSA 的 AYSRH 战略政策和规划方法提供了重要证据,并为在可持续发展目标背景下实现他们的权利提供了依据。
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