DR DESIREE GOVENDER, PROF SALOSHNI NAIDOO, PROF RELEBOHILE MOLETSANE, DR GLORIA NKABINDE, PROF MOTSHEDISI SEBITLOANE and PROF ANNA VOCE
Durban — Adolescent pregnancy is common in South Africa with data pointing to an “epidemic” of adolescent pregnancy putting strain on our healthcare systems and societies.
In 2021, Statistics South Africa reported that 142 704 births registered occurred to mothers aged 10 to 19 years.
KwaZulu-Natal has the highest prevalence of adolescent pregnancy with 36 171 deliveries recorded in girls aged 10 to 19. Further, repeat births to adolescents is an untold story in South Africa warranting attention. Specifically, in the schooling system, the Minister of Basic Education, Angie Motshekga reported to parliament that 91 000 learners fell pregnant in 2021.
The South African Council of Educators (SACE) identified blessers and teachers as responsible for impregnating 11 000 learners in Limpopo in 2022. This emerging data represents the spiralling sexual and gender-based violence (SGBV) against adolescent girls which exacerbate sexual and reproductive health problems like unplanned pregnancies and sexually transmitted infections. Worryingly, the prevalence of repeat pregnancy amongst a sample of 326 adolescent girls attending maternal healthcare services at a district hospital in Ugu, KwaZulu Natal was 19.9%.
Repeat pregnancies among adolescent girls indicate the growing problem of high-risk sexual behaviour and the status of reproductive health services. While females bear the brunt of the consequences of adolescent pregnancies, we must be cognisant of the prevalence of adolescent fathers, reported at approximately nine percent in KwaZulu-Natal.
Adolescent pregnancy does not occur in a vacuum but is a result of interrelated economic and social factors, like poverty, level of education, family and peer relational dynamics, community and environmental contexts, and health and social systems. In addition, power dynamics, SGBV, and gender inequalities are also strong predictors of unplanned adolescent pregnancies in South Africa. Due to the power dynamics, young women are coerced or forced against their will into sexual relationships at an early age as evidenced by the number of adolescent mothers with older partners.
These power dynamics extend beyond the family setting to the community and schools, a place in which one should be safe. The number of adolescent mothers as a result of abuse by their male teachers is a concern in South African communities. In South Africa, sex with a girl below 16 years (or where the male partner is two years older than the girl), is considered statutory rape. It is increasingly difficult, if not futile to attempt to report the matter to social workers and police.
Often no one knows among the caregivers, the process to follow, where attempts are made to seek help, the young girl herself or her family are reluctant to pursue the matter further, since the families of the boy and girl have already made their own bilateral agreements. In some instances, where the case is reported to the police, the perpetrator pays money to the girl’s family who then withdraws the case, often without consulting the girl.
Adolescent pregnancy is often unplanned and unwanted and tends to intersect in complex ways with factors such as partner rejection, abandonment, strained family relationships, SGBV, and psychological distress. Within this context, adolescent pregnancy is more than a physical experience embodying experiences and perceptions of social norms, discourses, conflict, and moral judgment.
Early childbearing is associated with an increased incidence of HIV infection and poses a challenge to HIV prevention strategies. For many adolescents, pregnancy often means the end of the girls’ participation in education perpetuating inequality, poverty, poor health across generations, and negative social consequences for the mother, child, and family.
Being an adolescent mother results in stigmatisation, seen when the mother tries to access healthcare services, often berated by health professionals, at school when they attempt to complete their education and within the community as they raise their children.
Research shows that children born to adolescent mothers have worse educational outcomes compared to their counterparts perpetuating poverty cycles.
We must proceed with caution when believing that all adolescent pregnancies are unwanted and unintended. Early childbearing and the proof of fertility dominate the discourse on the transition from childhood to adulthood. Social, cultural, and gender norms cannot be alienated from early childbearing.
What is needed, therefore, is an integrated system of education, care, and support that involves sexual and reproductive health and rights services, including adolescent-friendly education, health and social programmes. Furthermore, pregnancy is often dealt with medically with little regard for the mental health and well-being of the mother.
Pregnant and parenting adolescent girls are more likely to suffer from depression than their adult counterparts. Psychological issues experienced by pregnant and parenting adolescent girls in South Africa include anxiety, suicidal ideation, guilt, loneliness, anxiety, and stress. Mental health support services often absent, are needed for adolescent mothers, especially when the pregnancy is a result of SGBV.
Thus, adolescent pregnancy is plagued by multifaceted challenges that require an integrated response by the family, community, civil society, and local and national authorities.
While in theory, the Life Orientation and life skills curricula cover issues related to sexuality education, teaching these topics tends to be challenging for teachers, and many avoid it or do so inadequately and inappropriately. Importantly, in many classrooms, curricular efforts have not included access to pregnancy-preventative methods.
The role of family and community as a support system in preventing and reducing adolescent pregnancies is important. Adolescents who live with both parents or with a positive adult role model are less likely to fall pregnant. Positive social influences, social efficacy, and communication by parents, peers, and community members are known to reduce the burden of adolescent pregnancies in communities, elements that must be included in prevention programmes.
Finally, it is of utmost importance that adolescent mothers are also not left behind with regard to care and support. Engaging men and boys in adolescent pregnancy prevention efforts are crucial in protecting women and girls from harmful gender norms and SGBV.
The collaboration of professionals from various related sectors to assist adolescent mothers in achieving better health and psychosocial and socio-economic outcomes guiding them to a better future should be a key policy priority in the South African context.
As academics at the University of KwaZulu-Natal, we are committed, through our research, community engagement, and training, to work with schools, communities, adolescents, and all other stakeholders to raise awareness and co-develop and implement contextually relevant solutions to respond to unwanted and unplanned Adolescent Pregnancy.
Dr. Desiree Govender and Prof Saloshni Naidoo are in the Discipline of Public Health Medicine at the School of Nursing and Public Health.
Prof Relebohile Moletsane is Chair in Rural Education at the School of Education. Dr. Gloria Nkabinde is in the Discipline of Family Medicine at the School of Nursing and Public Health.
Prof Motshedisi Sebitloane is in the Discipline of Obstetrics and Gynaecology, School of Clinical Medicine.
Prof Anna Voce is in the School of Nursing and Public Health
Daily News