When children have children
The shockingly high number of teenage pregnancies worldwide is both a problem for health and for society. Besides major risks for mother and child and a greater likelihood of fatal complications, teenage pregnancy also jeopardises girls' social and financial future.
Zimbabwe In the morning of 26 August 2021, a newborn baby is found in front of the entrance to a local supermarket in Zaka, around 340 kilometres south of the capital Harare. The baby is wrapped in a school jumper – an indication that he is the result of an unplanned teenage pregnancy. The umbilical cord is still bleeding; the baby boy was probably born in the night and left in the doorway.
It is estimated that half of all pregnancies worldwide are unplanned. Despite positive developments, most unplanned pregnancies occur in sub-Saharan Africa. This is despite the fact that in most places, people are legally free to choose whether they want to have children and how many, and contraception is widely available. Yet in reality, many women are denied this basic right of self-determination. This right would be bolstered by greater gender equality.
Teenage pregnancies equal health risk
In underage girls in particular, pregnancy carries major risks. Estimates suggest that there are 21 million pregnancies a year in adolescent girls aged between 15 and 19 in low- and middle-income countries. Around half of these – in other words over 10 million – are unplanned. Almost a third of women in these countries are under 19 when they have their first child. They have children when they are still children themselves.
A girl's body is not yet fully prepared for pregnancy and complications for both mother and child are more common than in older pregnant women. The leading cause of death worldwide in women and girls aged between 15 and 19 is pregnancy and birth complications. This is due to the higher risk of eclampsia* and uterine infections compared with adult women. In addition, the stigma and despair of falling pregnant at a young age often leads to unsafe abortions. In teenage pregnancies, babies are more likely to be born prematurely or with low birth weight.
Focus on healthcare services for adolescents
The World Health Organization recommends eight quality standards for adolescent healthcare. SolidarMed helps to implement these standards in programme countries. Unfortunately, healthcare services are often not tailored to the specific needs of young people and are therefore not well accepted in this age group. Adolescents experience a lack of respect from nurses, a lack of privacy and confidentiality, and fear of stigmatisation and discrimination. As a result, many fail to seek medical treatment, which can have unintended consequences for health and lead to early pregnancies. Reducing the number of teenage pregnancies is a target of the UN's Sustainable Development Goals 3 and 5.
It is not only the health risks that pose a major problem, but also the social ones. The girls affected are forced to drop out of school and it is often inevitable that they will slip further into poverty, particularly if they are abandoned by family members or the babies' fathers. The reasons why the mother abandoned Innocent – the little boy left in front of the supermarket – are merely speculation. But we can assume that she faced similar issues.
Child marriage and lack of awareness among adolescents
In Zimbabwe, 30% of maternal mortality is due to early pregnancies, which occur in particular because child marriage is entrenched, access to contraception and education for adolescents is lacking, and girls are often victims of abuse. Although Zimbabwe made it illegal in 2020 for schools to expel pregnant girls, the reality is often quite different. The government took action last year and set 18 as the minimum age of marriage. The number of child weddings further increased during the Covid-19 pandemic, and is much higher in rural areas than in towns and cities. There is therefore a lot of work to do until the law has an impact. There is a lack of information on contraception and sex education including on the rights that young people have. On top of that, medical services are often not tailored to adolescents – whether in terms of contraception services or prenatal care.
SolidarMed focuses on reproductive health
SolidarMed already recognised this problem a number of years ago, and prioritised the sexual and reproductive health of adolescents in the Masvingo province. At the community meetings launched by SolidarMed, villagers indicated that a lack of knowledge about sexuality and reproduction in young people was the main reason for teenage pregnancies and required immediate attention. They said that young people needed to be educated and given information early on.
«These meetings arm us with information so we can have sensible conversations about sexuality and reproduction with our kids.»
A mother after the meeting for parents.
Traditionally, sex education is the responsibility of aunts and uncles. However, due to financial difficulties, more and more adults are forced to leave their communities to look for work in cities. These traditions and structures are therefore being eroded, leading to gaps in children's and adolescents' knowledge. At the community meeting it was clear that parents are overwhelmed and don't know how to broach the subject and talk about these issues with their children. At the same time, they realise that times have changed and want to play an active part. Together with national health authorities, SolidarMed decided to support parents and introduced courses on how to talk to children about relationships, development and sexuality.
Anna Mubaiwa, a community health worker from the Pahlela Health Centre, meets a group of nine parents from her community while their children are at school. She is talking to them today about sexual relationships in general. "These meetings have armed us with information so we can have sensible conversations about sexuality and reproduction with our kids. Before, I had no idea how to have those sorts of conversations," a mother says, after the meeting. The parents are also told that it is illegal to marry their daughters off before the age of 18 and that if they do, they could be prosecuted.
At the weekend the community health workers are holding a meeting on the same topic with the children. In particular, the information is age-appropriate and in some cases delivered by peers. The groups of young people are split by age, with 10- to 13-year-olds separated from the 14- to 19-year-olds. For both parents and children, it is about talking and sharing freely and openly.
The goal is clear: the frequency of teenage pregnancies, but also sexually-transmitted infections and HIV need to be reduced. Young people need to be aware of their rights. And for the girls who fall pregnant early, there are self-help groups supported by SolidarMed where they can meet others in a similar situation. Expectant mothers are also educated about the possibilities and importance of pregnancy check-ups and encouraged to get them.
«I'm now equipped to answer my son's questions.»
A participant after the meeting for parents.
Because SolidarMed and the Zimbabwean health authorities declared the topic a priority, healthcare facilities are also involved directly. Studies show that 67% of girls aged between 10 and 19 have nowhere to go where they can access sexual and reproductive health services. However, in Zimbabwe financial resources are lacking, which is why SolidarMed is plugging this gap.
Healthcare workers are trained so that young people can access high-quality and personalised healthcare services in a safe space. Mental health also has an important role to play in educating and empowering the adolescents and making them more resilient. Ultimately, they are the key to the future health and prosperity of the community. Investment is also made in infrastructure where it is urgently needed, whether because there are no delivery tables, or no running water on the labour ward, which encourages infections.
The abandoned baby Innocent is now in safe hands. The case was reported at the time to the police, who brought the baby boy to the district hospital in Ndanga while social services tried to find him a home. However, due to a lack of financial resources, neither the hospital not the social services department could look after him directly. SolidarMed got involved. The little boy urgently needed baby formula to survive. SolidarMed therefore included him on the baby nutritional programme (see page 13). Innocent is now 18 months old and has been taken in by loving foster parents. He is in good health and is putting on weight.
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