Influential contextual and institutional dynamics

As seen in the sexual offences legislative process, the national RH policy process also depicted the clash between international narratives versus national narratives of SRH in Kenya. While the policy development process was a response to the ICPD narrative of rights as regards SRH, the process marginalised SRH rights actors and women’s voices in order to focus on contextually non-sensitive technical solutions to SRH challenges. Thus, the dominant narrative of women’s rights from the ICPD and Beijing conferences was replaced by the moralised medical narrative in the national RH policy process so as to avoid controversy and opposition by projecting the policy process as neutral and evidence- driven. While the policy content acknowledges RH rights, it qualifies these to refer only to those issues that are not prohibited under Kenyan law.

The influence of the local socio-cultural and political contexts was further evident in the important role played by the narratives of morality and culture – often internalised and supported by many Kenyans – in shaping the policy deliberations and content. The policy was developed by Kenyans whose views on sensitive SRH issues are shaped by the local socio-cultural norms and values that are largely a product of Christianity, Victorian era English law, and patriarchy as noted in Chapter 3. For instance, respondents noted that the views of key actors especially those from government on issues of abortion and

homosexuality largely reflected the Kenyan society’s general opposition and stigmatisation of these issues. A respondent who was involved in the policy process noted that it was common to hear ‘people saying this is how we do it or we can’t do that here’90. In addition, the longstanding political and religious opposition to sensitive SRH issues (adolescent contraception, abortion, and homosexuality) meant that actors involved in the policy process were unwilling to even discuss these issues or have the policy address them as they feared this would attract controversy and opposition. The two lead consultants on the policy argued that their appreciation of the Kenyan context meant that the policy network avoided highly controversial SRH issues. Moreover, top bureaucrats at the DRH and Ministry of Health, whose role it was to ensure the policy was approved and signed by government, could not allow the inclusion of issues they perceived as not supported by top political leadership in order to safeguard their careers. Thus, the politically embedded narratives of morality and culture underpinned decisions by the policy network to omit sensitive SRH issues in the policy.

6.6 Conclusion

This chapter deconstructed the policymaking process that produced the 2007 national RH policy in Kenya in order to discern the drivers and inhibitors of change that shaped the resultant policy. As the preceding discussions have shown, the national RH policy process aptly captures how different SRH narratives influence the interplay of actors, knowledge and context that produce and shape SRH policy reforms in Kenya. Newly deployed medical professionals in the DRH selectively organised actors from donor and international-type agencies supportive of the ‘politically-approved’ moralised medical narrative into an epistemic community. The interactions within the epistemic community were both influential and facilitative as they did not only produce the need for a policy, but also provided the necessary technical and financial resources for the policy development process. Besides socio-cultural and political opposition to sensitive SRH issues, the role of USAID in the epistemic community as the main funder of the policy process as well as the funder of most of the organisations in the epistemic community, could have foreclosed any meaningful debates on sensitive SRH issues given the US government’s policies, such as the ‘global gag rule’ and ‘abstinence-only’ funding policy for adolescent SRH programmes. Moreover, the deliberate locking out of the local and international SRH rights organisations from the epistemic community denied them any influence on the policy and weakened the rights narrative within the network. Even so, the focus of rights actors at the time was mainly abortion, and so even within rights groups, gay rights and adolescents’ access to contraception had been marginalised.

The publishing of new positivistic knowledge on SRH indicators (mainly from the KDHS) stimulated the epistemic community’s push for an RH policy. Given the community’s dominant moralised medical narrative underpinned by its own as well as political interests, it marginalised knowledge on sensitive SRH issues in the policy development process, pointing to the limitations of scientific knowledge in bringing about policy change. The focus on biomedical knowledge as well as the side-lining of rights actors in the policy process aimed to give the policy process the image of ‘a neutral, objective and ‘politics-free’ process’ by masking the politics of religious and patriarchal control of SRH that were undoubtedly at play. Nevertheless, scientific knowledge played a critical role in ensuring that post-abortion care is provided for by the policy despite opposition. Respondents argued that facility level data showing the extent of patients seeking emergency care for complications of unsafe abortion helped make the case for inclusion of post-abortion care. Medical actors’ framing of complications arising from unsafe abortion as ‘medical

emergency’ was instrumental in justifying the need for the policy to provide for post- abortion care.

The struggle between international level narratives of rights and comprehensive medical versus locally dominant narratives of morality and culture in the policy process pointed to the different power dynamics at the international level and at the national level in Kenya. This resulted in sensitive SRH issues (abortion, adolescent contraception, homosexuality) being marginalised and omitted in the policy, given the influential position of religious, political and bureaucratic actors at the national level versus the non-influential position of rights actors. Indeed, the influence of the moral narrative was so strong that the policy took the absolutist stance of the Catholic church on abortion, when it failed to provide for safe abortion in cases where abortion is legal under Kenyan law. Some respondents who participated in the policy development process argued that they focused on self-censoring in order to avoid controversy and opposition. Thus, compromises were made to exclude abortion (and only talk about post-abortion care), sexual minorities, and the language of rights, particularly ‘sexual rights’, from the policy in order to avoid backlash from religious and political leaders. The evident marginalisation of the needs and interests of groups that lack power at the ‘decision-making table’ (i.e. adolescents, women, and sexual minorities) remains a paradox to the policy’s slogan ‘Enhancing reproductive health status for all Kenyans’.

Overall, different narratives representing different actor interests competed to either create or block space for SRH policy reforms in Kenya. The narrative of SRH as rights that emerged from the ICPD, and which focused on gender equality and non-discrimination, opened the initial space for policy reforms on SRH in Kenya. However, the powerful moral and cultural narratives at the national level, and which mainly masked the interests of religious groups and men in controlling women’s and adolescents’ sexuality and

reproduction, interacted to block reforms on sensitive SRH issues. Although the medical narrative was adopted by local actors to marginalise SRH-related politics and interests by presenting a ‘neutral evidence-based’ front, it had to take a moralised slant by marginalising sensitive SRH issues in order to receive political backing, confirming that health

policymaking is, by all accounts, a political process. In the next chapter, a synthesis of the three policy processes discussed in Chapters 4-6 is provided with the overarching aim of interrogating the political nature and the power dynamics of SRH decision-making in Kenya.