Hilda has served as a peer navigator at the MTRH-Rafiki Centre for Excellence in Adolescent Health at AMPATH for six years, working with pregnant and parenting adolescents.
Approximately 15 percent of Kenyan adolescent girls 15-19 years old have either had a live birth or are pregnant with their first child. Globally, evidence suggests an estimated 14 percent of adolescent girls and young women give birth before the age of 18. Across Kenya, many women deliver at home without skilled birth attendants, increasing their chances of birth trauma, hemorrhage, infection, and maternal or neonatal death.
Many adolescents lack supportive communities both throughout their pregnancy and after their child is born due to stigma associated with pre-marital sex and adolescent pregnancy. Findings demonstrate that fears of becoming pregnant are motivated by worries that their community will find out that they are sexually active.
Without supportive relationships in the home or community, adolescent girls in resource constrained and rural communities frequently face challenges in receiving basic pregnancy care.
In African countries, peer navigators have been shown to provide connective care for adolescent pregnant and parenting people. Adolescent peer navigators are young people who, through lived experience, are able to connect and collaborate with adolescent in need of care.
Peers serve as a necessary bridge between patients and clinical providers, often working to alleviate the stigma associated with their lived experience. Peer navigators work within clinic systems and in the community to increase patient care, engage them in needed services, support medication adherence, and provide social support, among others.
Hilda has served as a peer navigator at the MTRH-Rafiki Centre for Excellence in Adolescent Health at AMPATH for six years, working directly with pregnant and parenting adolescents. Hilda is studying counseling and psychology, and has a passion for developing mental health resources for this population. Hilda sat down with Ashley Chory, Global Youth Health Senior Program Manager, to discuss her passion for helping others and advocating for more resources for pregnant adolescents.
What does the day in the life of a peer navigator working with look like?
I have been working as a peer navigator at the Rafiki Center for six years. A peer navigator is someone who works as a link between adolescents and the clinical team. It really helps the adolescents because the peer navigators work as a liaison to eliminate barriers between them and the clinical providers. Often times, adolescents do not feel comfortable opening up to a nurse about certain topics.
As a pregnancy peer navigator, I do retention work, which entails taking the client documents, holding one-on-one sessions, conducting support groups, and following up on those who come to the clinic. When adolescent girls take a pregnancy test, if they are positive, the clinical team hands the pregnant adolescent to me. I advocate for pregnant teenagers’ rights, safety, access to care, and referrals. Immediately, they are transferred to the Maternal Child Health facility where they deliver. I also work with pregnant adolescents who are not doing well; there is a lot of stigma around adolescent pregnancy, which is seen as a consequence due to having sex before marriage. They do not have the support needed because society views pregnancy in adolescence as taboo. Sex is a taboo subject for young people; however the reality is that adolescents are engaging in sex. Because of this stigma around pregnancy, adolescents drop out of school, but they do not get the necessary financial and psychological support needed. I believe it is crucial to have adolescent peer navigators who have been through similar experiences to support them. They might even need a psychologist to step in and assist them through this difficult period.
How has being a peer navigator changed your life?
Being a peer navigator has significantly improved my self-esteem. Now I feel like I can contribute to society. I can connect adolescents to the services they require, which has enhanced my overall skills. As a psychologist, I used to be shy, but now I perform at a professional level. I can now speak to large crowds without feeling anxious.
What are some of the challenges young people who you work with face?
Adolescents need to have access to a social support program because it allows me, as a peer navigator, to understand what kind of advice I can give by learning from their lived experiences. There are general support groups for anyone who is HIV positive, but there is a need to have groups for pregnant girls only. The pregnant girls I work with lack financial assistance, and their mental health is a contributing factor. Pregnant girls also experience postpartum stress since they are unsure of what to do because they have dropped out of school, are unable to take care of themselves, and have been disowned by their parents. This is an extremely difficult time for these adolescent girls and I want to help them.
When you see a young child, there needs to be a visible connection between the parent and the child. The girls may not be properly taking care of the child because they did not realize the responsibilities were much more significant than expected. At the Rafiki Center, there are no longer services available to teach the girls what they need to know on becoming a parent. There used to a program which included support groups and chamas, but it stopped due to COVID-19. Some of the topics included parenting practices, self-care, mental health, empowerment after childbirth, and how to assist the child.
What motivates you as a peer navigator?
My motivation is helping adolescents. If the adolescents are happy, and I can see that I did something good, that greatly inspires me, regardless of my personal problems.
How would you describe yourself?
I am patient, a people’s person, and have the ability to be accommodative.
What do you want the world to know about young people and young people in Kenya?
I want the world to know that young people are unique. They must be heard, listened to, and given a safe space to express themselves without being judged.
If you had three wishes, what would they be?
I would like to earn a higher wage and become a well-known psychologist. I wish to create an entire center dedicated to assisting adolescents regardless of their HIV status. Finally, I want to highlight peer navigator programs because they play an important role in demonstrating that it is possible for adolescents to pursue a career in this field.
Sakshi Sawarkar, MPH is an Associate Researcher, Arnhold Institute for Global Health and Department of Global Health and Health System Design
Ashley Chory, MPH, is the Senior Program Manager, Global Adolescent Health at the Arnhold Institute for Global Health at Mount Sinai and the Department of Global Health and Health System Design.