Understanding the drivers of change in sexual and reproductive health policy and legislation in Kenya

Oronje, Rose Ndakala (2013) Understanding the drivers of change in sexual and reproductive health policy and legislation in Kenya. Doctoral thesis (PhD), University of Sussex.

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Abstract

The thesis explored the drivers and inhibitors of change in sexual and reproductive health
(SRH) policy and legislation in Kenya. The overall purpose was to contribute to the limited
knowledge on national-level debates that shape how developing countries adapt the SRH
agenda, which originated from international processes. The thesis explains how and why
some SRH reforms have been realised in Kenya amid contention, while others have been
blocked. Guided by a synthesis conceptual framework that emphasised the central role of
discursive power in decision-making, the thesis adopted a qualitative case-study design
enriched with various anthropological concepts. Three case-studies (two bureaucratic, i.e.
adolescent RH policy and national RH policy, and one legislative, i.e. sexual offences law)
were deconstructed. Data collection involved semi-structured in-depth interviews with
policy actors, observations and note-taking in meetings, and document review.

Findings revealed that four influential narratives of SRH – the moral narrative, cultural
narrative, medical narrative (with two variations i.e. ‘moralised’ versus ‘comprehensive’
medical narratives), and human rights narrative – underpinned by conflicting actor
interests, mediated the interplay of actor networks, knowledge, context and institutions to
determine reforms. The findings revealed that the strong entrenchment of the moral and
cultural narratives in the Kenyan context (mainly public structures and institutions) was a
major barrier to reforms on contested SRH issues. Even then, the hegemonic narratives
were in some cases unsettled to make reforms possible. The most important factors in
unsettling the hegemonic narratives to facilitate reforms included: a change in the political
context that brought in new political actors supportive of reforms, the presence of
knowledgeable and charismatic issue champions within political and bureaucratic
institutions, the availability of compelling knowledge (scientific or lay) on an issue,
sustained evidence-informed advocacy by civil society/non-governmental organisations,
donor pressure, and reduced political costs (for politicians and bureaucrats) for supporting
reforms.

The main contribution of the thesis is three-fold. First, the thesis captures the disconnect
between international SRH agreements and national-level realities, showing the need for
international actors to consider national-level realities that shape decision-making. Second,
its findings provide lessons for informing future SRH reform efforts in Kenya and in other
sub-Saharan African countries. Third, its analysis of discursive power contributes to a
major theoretical gap in health systems research in developing countries identified as lack
of critical analysis of power in decision-making.

Item Type: Thesis (Doctoral)
Schools and Departments: Institute of Development Studies
Subjects: H Social Sciences > HN Social history and conditions. Social problems. Social reform
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0773 Personal health and hygiene Including clothing, bathing, exercise, travel, nutrition, sleep, sex hygiene
Depositing User: Library Cataloguing
Date Deposited: 03 Oct 2013 15:58
Last Modified: 17 Sep 2015 11:58
URI: http://sro.sussex.ac.uk/id/eprint/46469

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