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New Vision is highlighting the challenge of teenage pregnancy in Uganda with a view to finding a solution to the problem that costs Ugandan taxpayers up to sh250b a year in healthcare. 

In the third of 12 stories, Agnes Kyotalengerire explores the economic and social cost of teenage pregnancies to the economy.

It is a fundamental human right for young girls and women to live vibrant and dynamic lives where they can pursue their aspirations. 

However, this is not the case for young girls in Uganda as about four out of 10 aged between 15 and 19 become pregnant and later grapple with significant health, social and economic challenges. 

Not to mention, the trouble of raising the children single-handedly. The cost of teenage pregnancy impacts on economic development of the country. 

Affected are young adolescent girls and their families. It impacts national development in varied ways.

Economic cost 

Teenage pregnancy causes a lot of economic burden, according to Prof. Augustus Nuwagaba, an international consultant on economic transformation. 

Teenage mothers are six times less likely to complete secondary education compared to non-teenage mothers.

First and foremost, when a girl becomes pregnant and drops out of school, the family and the entire nation lose the contribution she would have made towards supporting her family and being productive to the country. 

As such, the girls drift into abject poverty because often they are abandoned by the men who impregnate them. Consequently, they begin to depend on their parents for survival. 

Prof. Nuwagaba says gradually, the economic burden is transferred to the parents (elderly) given that the majority of young mothers tend to entrust the care of their babies to their parents. 

This also causes economic strain on the health sector. The annual out-of-pocket expenditure by families of teenage mothers on healthcare in 2020 totalled to about sh1.28 trillion ($290m). 

The estimated health facility expenditure on teenage mothers was about sh246.9b ($70m), according to The Cost of Inaction 2021 report. Collectively, this is equivalent to 43% of the Ministry of Health budget. The largest amount of expenditure is spent on normal delivery and care for newborns. 

Nuwagaba says this money would have otherwise been used to set up critical infrastructure, such as constructing roads or equipping health facilities with adequate drugs.

Health 

The health implication associated with young people becoming pregnant too early is huge. For example, pregnancy causes physiological strain on teenage girls. 

When young girls become pregnant, the risk of developing complications during pregnancy, labour and delivery increases, says Dr Andabati Gonza, a gynaecologist at Bethany Women Hospital in Luzira, Kampala. 

This is because their pelvic bones are narrow since they are not well developed. 

As a result, they develop complications, such as prolonged obstructed labour, which can result into long-term health conditions, such as obstetric fistula. 

Obstetric fistula is a wound that leaves a hole in the birth canal and makes a woman to leak urine or faeces from the vagina. 

Additionally, teenage mothers have a higher risk of bleeding during birth because of tears and the preceding difficult labour. Even when they may require to be operated upon to deliver safely, the caesarean section services may not be easily available, he says. 

Some teenage mothers become anaemic, while others get malnourished babies because they can not afford a balanced diet to meet their nutrition needs of pregnancy. This impacts the health and growth of their babies. Sadly, some girls have contracted sexually transmitted infections (STIs), including HIV, yet the country is struggling to reduce the prevalence of HIV infections in the communities. 

The country’s projections of May 2023 reveal that of the 52,000 new HIV infections that Uganda registered between 2021 to 2022, about 19,300 new HIV infections occurred among adolescents and young people aged between 15 and 24. 

Of those, about 14,000 new HIV infections happened among girls compared to about 5,300 that occurred in boys. 

This translates into new HIV infections among adolescent girls being three times higher compared to boys. 

Infant, maternal mortality

Teenage pregnancy contributes to 20% infant deaths in Uganda and as well as maternal deaths. If no action is taken to reduce teenage pregnancy, teenage mothers may continue to suffer the most from deaths arising from reproductive health challenges, such as abortions. 

The Institutional Maternal Mortality report of 2020/2021 reveals that about 66% of maternal deaths that occurred were among women aged 25 and above, followed by 22% among the 20-24 years and 12% among teenage mothers. 

When young girls become pregnant, their education is affected.

The same report reveals that about 34% of maternal deaths were of adolescent girls and young women. The death of a mother leaves a big gap in her family with no one to take care of the orphaned children. 

Health experts warn that unsafe abortion could result in irreversible damage on the female reproductive system. 

Motherhood at risk

Information from Kawempe Hospital shows that every week, the facility registers girls and women with complications associated with unsafe abortion. 

“We see young girls and women come to us with incomplete abortion,” Dr Rachael Nanzira, the deputy clinical head at Kawempe Hospital, said. Nanzira added that the most affected are young girls aged between 13 and 20. 

The girls report to the hospital when they are bleeding severely and are anaemic. 

Shatters career dreams 

Teenage pregnancy denies adolescent girls an opportunity to remain in school, consequently affecting their future careers and shatters their dreams and childhoods, says Dr Fredrick Makumbi, an associate professor at Makerere School of Public Health. 

“Teenage girls are supposed to be in school gaining education and getting skilled so that they can prepare for the future. However, when the young girls become pregnant, their education is affected,” Dr Makumbi says. 

The Cost of Inaction report of 2021 reveals that teenage mothers are more likely than non-teenage mothers to attain only primary-level education. 

On the other hand, teenage mothers are six times less likely to complete secondary education compared to non-teenage mothers. Therefore, keeping girls in school reduces teenage pregnancies. 

In addition, teenage mothers are three times less likely to have professional jobs and twice more likely to be self-employed in agriculture. This is corroborated by data from the World Bank 2016 report that indicates that primary school completion rate in Uganda stands at 52.6%. This means that for every 10 pupils who enrol for primary school, only five sit Primary Leaving Examinations (PLE). 

Another World Bank study found that in Africa, each year of school raises average earnings by 11.3% for males and 14.5% for females. Teenage pregnancy should be a concern of everyone, according to Ritah Aciro, the executive director of Uganda Women Network. 

“It is an abuse of fundamental human rights. It takes away the dignity of the girl-child. It takes away the innocence and childhood of a child,” Aciro says She further notes that the vice reduces the economic and professional potential of the citizens because the girls are not educated and well-skilled. 

Consequently, this slows growth and development. Not forgetting, it is s gross sign of a lack of sexual reproductive health rights and services (SRHRS) for young people. Consequently, it reduces their potential and opportunity for a better life and future. 

Specifically, on the issue of child marriages, there is no marriage for anyone below the age of 18 years. We should stop calling it that. It is abuse and impunity. Let us not sugarcoat it,” she notes. 

Aciro adds: “The biggest dilemma for us as a country is that these young people are our challenge of today and tomorrow.” 

Dr Euzobia Mugisha Baine, the director of gender mainstreaming directorate, Makerere University, regrets that we have let the girls down by accepting early marriages, excusing sexual offences even against children, blaming the victims of sexual harassment and not the perpetrators, who are predominantly older men and not adequately ostracising sexual offences.

We risk harnessing demographic dividends 

The issue of teenage pregnancy requires urgent attention, according to the director general of National Population Council, Dr Jotham Musinguzi. Dr Musinguzi said Uganda has a demographic dividend roadmap and the aspiration is to harness the potential of young people who constitute about 78% of the population. 

He, however, warns that the issue of teenage pregnancy may derail the country from achieving the target, if not addressed. 

The cost of teenage pregnancy impacts on economic development of the country.

The United Nations Population Fund defines demographic dividends as the economic growth potential that can result from shifts in a population’s age structure, mainly when the share of the working-age population is larger than the non-working-age share of the population. 

“The Government policy is to empower young people to get educated, get skills, get jobs and subsequently form a strong foundation of quality population. However, Teenage mothers during financial literacy class if the young people become pregnant early, the ability to continue with education, get skills and employment is disrupted,” he said.

The burden 

The national teenage pregnancy rate has stagnated at 25%, according to the Uganda Health Demographic Survey (UDHS) 2016 report, even with efforts that the country had invested in, aimed at reducing the figure to 15% by 2020. 

This was a decline from 31%, according to the UDHS 2000 report. The indicators, thereafter, stalled at 25% from 2006 to 2016. 

The UDHS results of 2020 are yet to be released. Inevitably, COVID-19 compounded the already existing magnitude of the problem arising from school closures, sexual abuse and exploitation of young people, limited access to integrated sexual and reproductive health, HIV, gender-based violence information and services, the increased decline in household incomes and job losses during Covid-19 lockdown. 

According to the District Health Information system-2 (DHIS-2), in 2021, the country recorded 31,565 pregnancies every month, which translates into 1,052 pregnancies recorded daily, including 250 children aged below 15 years who got pregnant monthly. 

The choice of inaction is, therefore, not an alternative for Uganda on her journey to harnessing the demographic dividend. 

This story was produced with support from WAN-IFRA, Women In News Gender Equality, Diversity and Inclusion (GEDI) grant. 

However, the views are not those of the sponsors.

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