Author’s note: Thank you to the street-connected mothers who came up with the program title, and who are helping to build this program and make it their own. All individuals in the above photo have consented to its publication.
The streets of Kenya are home to up to 300,000 children and youth (IRIN, 2007), many of whom reside in the city of Eldoret. These young people enter into a life on the streets for a number of reasons, the most common of which include extreme poverty, family conflict, and child abuse (Embleton, Lee, Gunn, Ayuku, & Braitstein, 2016). Others are simply born into it. Once introduced to the streets, youth are exposed to hostile physical and social environments that command their engagement in unsafe practices (Wachira et al., 2015), consequently compromising their physical and mental health (Wachira et al., 2016), their ability to earn an income (Wachira et al., 2016), and their chances of leaving behind their life on the streets. While the social, economic, and political challenges that plague the street community are multifaceted and intersecting, one opportunity for alleviating the constraints that inhibit these young people from transitioning off the streets lies at the very roots of society: the parent.
Street-connected youth live in either slums at the outskirts of town, or in barracks, which are little more than dump sites where they are free from the stares of onlookers. To cope with their harsh realities, the majority of children and youth sniff glue, a bottle of which they can too easily obtain from cobblers in town (Embleton, Atwoli, Ayuku, & Braitstein, 2013). While most have a strong desire to quit, the harmful and addictive inhalant distracts them from acknowledging a hunger that they cannot curb (Embleton et al., 2013) with the little bread and milk offered by local churches. Furthermore, their exposure to the elements, their close living quarters, and the unsafe practices demanded of them for survival, make them vulnerable to a variety of illnesses and infections, skin disorders, mental illness, malnutrition, HIV and other STIs, and injury (Braitsetin et al. 2013; Ayuku et al., 2003; Embleton et al., 2015).
Unfortunately, however, they have only each other to rely on, with many having little or no contact with family, and no ability to pay the fees to re-enter the school system. Negative perceptions and fear from the broader community compound these challenges. The county government, for instance, has been attempting to forcedly and violently eliminate youth from the streets by arbitrarily arresting them, or by rounding them up and dropping them at county borders (Blomfield, 2016), only to have them return to the streets because they have nowhere else to go. Additionally, any attempt by these children and youth to report rape, sexual or physical abuse, theft, or any other issues to the police, is met with contempt, and with the justification that said issues should be resolved within the street community itself (Wachira et al., 2015). Thus, with no other form of support from society, and no space to have a voice, they are left with little choice but to depend on the street social network and its accompanying lifestyle, which can be detrimental to their health, and can ultimately cost them their lives (Wachira et al., 2015).
Girls as Mothers
Women and girls connected to the street are a particularly vulnerable population, as they hold little power in the street hierarchy, and are viewed as mere sexual beings (Wachira et al., 2015). As a result, they are regularly victims of rape and severe physical and sexual violence, oftentimes before even reaching puberty (Embleton et al., 2015). Furthermore, in the absence of having an education or employable skills, they are given little choice but to turn to transactional sex as a means of survival, accepting as little as 10-50 KES ($0.13 – $0.63 CAD) in exchange for sexual intercourse (Embleton et al., 2015). To compound sexual activity as a survival mechanism, pregnancy is in itself a way to survive on the streets. There is tremendous pressure placed on street-connected young women to become pregnant, in order to avoid being stigmatized by the street community, and as a means to please their partners (Wachira et al., 2016). In fact, because child bearing signifies a form of social status and pride for males, those females who are unable to conceive are subject to physical and verbal abuse (Wachira et al., 2016). Similarly, if they are discovered attempting to abort a child, then they, too, are subject to physical harm by their partner (Wachira et al., 2016). Resultantly, the vast majority of street-connected young women have children of their own.
While assuming the role of parent is accompanied by health, social, and economic challenges for any adolescent, those experienced by the street population in Eldoret are particularly complex (Wachira et al., 2016). Some such challenges faced by street mothers include severe physical and sexual violence, drug abuse, sexually transmitted infections, mental health issues, nutritional deficiencies, and stigma (Wachira et al., 2016). Each of these challenges intersect and reinforce one another, and exist as a result of a dynamic combination of social, political, and economic factors beyond the control of the individual. Embedded in these very complex issues are the bare essentials that these mothers must go without, such as diapers, soap, pacifiers, warm clothes, and food. As such, it remains difficult for them to exhibit positive parenting practices, particularly given that not only are many of them an age where they are in need of parents, but they also have likely not been parented themselves.
Parenting as a Catalyst for Change
The evidence in support of parenting interventions for improving the heath and wellbeing of children and parents is both compelling and expanding. Parenting interventions have proven effective in reducing violence against children, reducing the risk of anti-social and violent behaviour among children, reducing family stress, and improving maternal mental health (Knerr, Gardner, & Cluver, 2013). Furthermore, positive parenting during early childhood is associated with mitigating the effects of poverty on children’s mental and behavioural development (Okafor, Sarpong, Ferguson, & Satcher, 2014), and is predictive of lesser involvement in substance use behaviours, as well as a greater life expectancy (Clover et al., 2017). In Eldoret specifically, caregiver supervision and support has been identified as a protective factor for transactional sex and sexual violence (Embleton et al., 2017). As both of these are widespread within the street community, this offers yet another impetus for programming that focuses on strengthening parenting skills.
Beyond the resounding evidence in favour of positive parenting, front line workers and the street youth themselves have identified parenting skills as a skill set which has both the potential to improve their current circumstances, and to break the cycle of street involvement. In light of this, I am collaborating with a driven group of community volunteers, social and health workers, academics, and street youth, in partnership with Moi Teaching and Referral Hospital (MTRH) and the Academic Model Providing Access to Health Care (AMPATH), to pilot an evidence-based positive parenting program for the street-connected mothers in Eldoret. It will be adapted from the “Parenting for Lifelong Health” program developed for sub-Saharan Africa, and will include weekly interactive group sessions that cover such topics as positive parent-child relationships, problem solving, praise and rewards, routines, and managing difficult behaviour, while incorporating lessons about child and parental rights and responsibilites, women’s rights, child health and hygiene, and other topics that the street youth identify as important to them. An adaptation of this program has tremendous potential, as the original program has demonstrated a reduction in child abuse, caregiver depression and stress, and substance use by caregivers and adolescents (Cluver et al., 2017). It has also led to an increase in parental supervision, household economic status, and social support (Cluver et al., 2017).
This program, supported by the World Health Organization, UNICEF, and a number of other academic and non-profit collaborators, has been scaled up and implemented in numerous countries throughout the world, including Kenya, however it has never been attempted with this very unique population. Thus, our goal is to determine if the “Parenting for Lifelong Health” program can be appropriately adapted to address the specific and diverse needs, challenges, and strengths of street-connected young parents, by engaging in a street youth-driven adaptation process, followed by a pilot of the adapted program. Responding to the request of the street community, the pilot will first target young mothers, with the goal of expanding to parenting couples once we have proven its success.
In order to adequately implement this pilot, I am looking to raise $5,000 to cover the costs of the planning team, many of whom are current or former street youth, as well as street outreach and mobilization, program facilitators, trainers and child care workers; translation services and printing for program materials; and food, transportation, and sanitary supplies for the mothers and their children during each program session.
If you would like to donate as little or as much as you can, please visit the project’s Go Fund Me page to help finance this initiative. With your support, we can all contribute to helping these historically neglected children and youth to not only survive, but to thrive.
Kathleen Murphy is an alumna of the Master of Public Health program at the Dalla Lana School of Public Health. She is currently volunteering in Eldoret, Kenya for Dr. Paula Braitstein, Associate Professor and CIHR Chair of Applied Public Health, University of Toronto at the Dalla Lana School of Public Health, and Visiting Professor at Moi University School of Medicine, Department of Medicine. This project is in partnership with Moi Teaching and Referral Hospital, and the Academic Model Providing Access to Healthcare (AMPATH).
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