Every day in Kenya, a girl who should be sitting in class is instead attending her first antenatal visit. 

Hundreds of thousands of adolescents register a first antenatal care visit each year, and while the numbers have been declining, the data reveal a crisis that official progress narratives tend to obscure. A significant share of those pregnancies involve children under 14, in counties where child marriage, limited schooling, and restricted access to reproductive health services compound the harm. 

“One in five pregnant women in Kenya is an adolescent, and adolescents are less likely to seek timely antenatal care,” according to the Kenya Demographic and Health Survey (KDHS), 2022.  

The Survey tracks adolescent first antenatal visits across three age bands: 10 to 14, 15 to 19, and the combined 10 to 19 cohort, covering all 47 counties across eight regions from 2022 to 2025. In 2022, there were 258,262 adolescent ANC visits nationally. By 2023, the figure stood at 251,500, before declining to 241,200 in 2024 and 235,938 in 2025. 

Nairobi City leads all 47 counties in absolute numbers, recording 16,072 adolescent ANC visits in 2022 and 14,291 in 2025. Kakamega in the Western region follows with 11,835, then Narok (10,934), Bungoma (10,443), and Migori (8,667). 

Kajiado carries a four-year 10-to-14 share of 10.2 per cent, matching Samburu, while Turkana reaches 11.4 per cent, the highest of any county. Mandera records 7.7 per cent and Wajir 7.9 per cent. These are counties where child marriage, limited schooling, and restricted access to reproductive health services converge with damaging results. 

The 10 to 14 age band: an underexamined emergency 

Nationally, children aged 10 to 14 accounted for an average of 4.5 per cent of all adolescent ANC visits between 2022 and 2025. In absolute terms for 2025, Kajiado led with 936 visits, followed by Garissa at 725, Homa Bay at 648, Narok at 601, and Turkana at 600. These are pregnancies in children who, in most parts of the world, would still be in upper primary school. 

The Sexual Offences Act of 2006 sets Kenya’s age of consent at 18 and criminalises defilement. The sexual activity leading to these pregnancies very frequently constitutes a criminal offence. Yet enforcement remains inconsistent, and institutional barriers to reporting are considerable. 

In 2025, the 10 to 14 age band recorded 397 total ANC visits among the ten least-affected counties, a 37.1 per cent decline from 631 in 2022. Nyandarua and Lamu both recorded just 10 visits, pointing to what is possible where protective conditions align. 

The contrast with the least-affected counties is instructive. Nyandarua’s 10-to-14 share of 0.7 per cent is the lowest nationally, suggesting that where schooling access, community norms, and child protection services function effectively, the incidence of under-14 pregnancy is far lower. Kirinyaga (1.2 per cent), Trans Nzoia (1.3 per cent), and Embu (2.2 per cent) also perform comparatively well. 

The 15 to 19 age band constitutes the overwhelming majority of adolescent ANC visits. In 2025, the national total for this cohort was 224,333. Nairobi City leads with 13,808 visits, followed by Kakamega (11,630), Narok (10,333), Bungoma (10,289), and Migori (8,282). 

The top ten most affected counties collectively recorded 96,337 visits in 2025, averaging 9,634 per county. The bottom ten recorded a combined 16,608, averaging 1,661 each. The gap reflects structural inequalities that cannot be resolved through health policy alone. 

West Pokot, with a four-year 10-to-14 share of 6.3 per cent, and Garissa at 7.2 per cent, both sit in mid-table for absolute visit numbers while carrying relatively high proportions of very young girls. 

What the World Health Organization says 

The World Health Organization’s (WHO) updated guidelines, revised comprehensively in 2025, recommend a minimum of eight antenatal care contacts for all pregnant women, with the first ideally occurring within the first trimester, at or before 12 weeks of gestation. The 2016 ANC framework had already moved in this direction, recognising that earlier and more frequent contact improves maternal and neonatal outcomes across all age groups, with particular significance for adolescents. 

In sub-Saharan Africa, the adolescent birth rate in 2021 was 101 births per 1,000 girls aged 15 to 19, more than double the global average. Although rates have declined across the continent, the actual number of adolescent births in the region remains the highest globally: an estimated 6.1 million for girls aged 15 to 19 and 332,000 for girls aged 10 to 14. Kenya sits firmly within this context, and its county-level data show how unevenly the burden falls within a single country. 

The WHO has been explicit about the health consequences of adolescent pregnancy. Girls under 15 face substantially higher risks of obstetric fistula, anaemia, eclampsia, and postpartum haemorrhage than older women. Neonatal outcomes are also worse: preterm birth, low birthweight, and infant mortality are all elevated when the mother is an adolescent, and more so when she is under 15. 

 The WHO’s 2025 guidelines for preventing early pregnancy identify six core areas for action: reducing child marriage, expanding access to contraception, broadening comprehensive sexuality education, keeping girls in school, providing adolescent-friendly health services, and addressing gender-based violence. 

The Ministry of Health response: progress and persistent gaps 

The Kenya Ministry of Health’s Maternal and Newborn Health Status Report, released in June 2025, recorded that 240,787 adolescents aged 10 to 19 presented with pregnancy at their first ANC visit in 2024, a 4.3 per cent decrease from 251,510 in 2023. 

A new Adolescent Sexual and Reproductive Health Development Impact Bond, launched through a UNFPA-led partnership in May 2026, will target ten counties carrying the highest combined burden of adolescent pregnancy and HIV. These include Nairobi, Mombasa, Kisumu, Homa Bay, Bungoma, Migori, Kisii, Nyamira, Kakamega, and Busia, several of which feature prominently in the KNBS county-level data. 

The geography of inequality, region by region 

The Rift Valley region carries a significant share of the national caseload, with Narok’s four-year 10-to-14 share at 6.5 per cent, Kajiado at 10.2 per cent, Turkana at 11.4 per cent, and West Pokot at 6.3 per cent among the most elevated in the country. The Nyanza region, encompassing Migori, Homa Bay, Kisumu, Kisii, Siaya, and Nyamira, consistently features in the upper tiers. Homa Bay’s 7.4 per cent share for the youngest age group is particularly concerning given the county’s concurrent burdens of poverty and HIV. 

The Western region, home to Kakamega and Bungoma, records the second and third highest absolute visit counts nationally. Both counties carry low four-year 10-to-14 shares of 1.9 and 1.7 per cent respectively, suggesting the concentration is primarily among older adolescents. This distinction matters for targeting: the interventions most relevant to a 16-year-old differ substantially from those needed for an 11-year-old. 

North Eastern counties including Garissa, Mandera, and Wajir record comparatively lower absolute numbers but carry some of the highest proportional shares of very young girls. Limited educational access, high rates of child marriage, and restricted women’s autonomy contribute to these patterns. At the opposite end of the scale, Nyandarua, Nyeri, Kirinyaga, and Lamu record the lowest absolute numbers across both age groups. 

The 2022 KDHS data found that only 59 per cent of women attended the recommended four ANC visits, and just 31 per cent presented within the first 12 weeks. 

Sources: WHO 2025, Kenya Economic Survey 2026, Kenya Ministry of Health, KNBS 2023, KDHS 2022, KHRC, UNFPA Kenya.

Data analytics & visualisation: Stanley Njihia    

Text: Yvonne Kawira