Story by Mourine Ooko, Health Economics Evaluation

At just 17, Akothee* from Homa Bay began a journey no adolescent should walk alone. Her story is about teenage pregnancy and the tragic consequences of a system unprepared to serve its most vulnerable. It shows, painfully, what happens when policies meant to protect instead create barriers that can create preventable hardship and, at times, cost young mothers and their children their lives.

I met Akothee through the C-IT-DU-IT study, a maternal health research initiative by KEMRI, LVCT Health, LSTM, and Kenya’s Ministry of Health. The study helps women access antenatal care (ANC) and encourages them to complete the recommended eight visits.

A Pregnancy That Began With Barriers

She first visited the local facility in January, seeking care for fatigue and nausea. A pregnancy test confirmed she was expecting. Being so young, she could not recall her last menstrual period, making it difficult to accurately estimate gestational age. Her first ANC visit should have included essential tests and an ultrasound, normally all covered by Kenya’s new national health insurance system, the Social Health Authority (SHA). However, SHA requires a national ID to register.

Many adolescents like Akothee lack a national ID, her mother had no insurance, and the family could not afford private tests. She left the facility without the investigations that could have guided her care. This was the first of many barriers that would shape her pregnancy.

When Poverty Meets Policy Gaps

Her mother, a single parent working as a house help to sustain eight children, could barely afford food, let alone medical fees. Because of this, Akothee could not return for follow-up visits for nearly two months, and this delay meant missing critical early screening.

She found much-needed support in a compassionate Community Health Promoter (CHP), who walked with her through each step and referred her for more advanced tests. But even with referrals, the financial gaps remained. The ultrasound fees at the referral facility were still out of reach.

Her pregnancy progressed without the investigations and access to care that many women receive without a second thought.

Delivery and Devastating News

When labour began, the situation quickly became complicated. She was referred for an emergency caesarean section at a private facility. After delivery, instead of the joy every mother hopes for, she was met with devastating news that her baby was born with a severe medical complication. It was the kind of condition that standard antenatal screening would almost certainly have detected.

I could not even comprehend what was wrong with my baby, though they talked to me and referred me to Homa Bay County Teaching and Referral Hospital for further treatment and care.

A Race Against Time

At the referral hospital, she was advised to seek specialised treatment in Eldoret. The cost of travel and care was beyond what any adolescent mother could handle and certainly beyond what Akothee’s family could ever afford.

She returned home, giving her baby the best care she could with the little she had. During one of our study team’s home visits, a staff member saw the gravity of her situation and mobilised support. Funds were raised for her SHA registration, transport to Eldoret, and some upkeep.

It felt like hope, finally, but it came too late. By the time specialists reviewed the baby, the condition had progressed too far. Curative treatment was no longer possible. She was advised to seek palliative care back home. Her baby passed away a week after discharge.

Grief and Strength in Equal Measure

Losing a child at such a young age is an unimaginable pain. Yet, Akothee, barely an adult herself, showed remarkable strength throughout her ordeal.

Yet even in her grief, Akothee remained composed, reflective, and determined that her experience should not be repeated. She has since begun speaking in her community about antenatal care and the challenges that adolescent mothers face showing great courage and resilience.

What Her Story Forced Me to Confront and What Lessons Need to be Learnt

As a young woman in my twenties, hoping one day to become a mother myself, watching her journey shook me deeply. I had to pause and re-think how fragile, yet powerful motherhood can be. I admired her courage, but I was also profoundly unsettled.

Because the truth is simple:

• Her baby did not die because she was young.
• Her baby died because the system did not give her a fair chance.

Akothee’s experience is not an exception unfortunately. Many teenage mothers in Kenya face the same obstacles: documentation requirements they cannot meet, poverty that delays or blocks care, referral systems that assume resources they do not have, and insurance schemes that remain out of reach despite promises of universality.

Her Resilience Deserves Admiration : Her Experience Demands Action

To provide true universal health coverage, adolescent mothers cannot remain invisible in policy design. There is a call for urgent reflection and reform to prevent stories like Akothee’s from repeating.

Policymakers, health leaders, and community health programs alike need to swiftly and adequately, prioritize teenage mothers and provide stronger support networks, which is all inclusive, and dismantling barriers in documentation and financial hurdles, that will create tangible support paths for young mothers.

Healthcare must transition from privilege to right. For Akothee, and those like her, her story beckons not just sympathy but transformative compassion and resolute change.

Names have been changed to protect privacy.