Children raising Children: What are we doing wrong?

By Catherine Mwesigwa Kizza

“When I was 17, I got a boyfriend at school. I asked my girlfriends about sex and they said you cannot get pregnant the first 10 days after your period. But I got pregnant. The boy was so scared he ran away, and my parents wanted to kill me. Luckily, a teacher from my school came along and helped me break the news to my parents. The teacher also told them that I could go back to school after giving birth. At first, my parents didn’t accept, but afterwards they were convinced. Now, I finished school at 20 years old and I want to be a teacher. I wish the topic is more discussed at school so that girls don’t make the mistake I did.”

Twenty-year old Phoebe from Uganda became pregnant when she was a teenager. Her story is one of several anecdotes from teenage mothers all over the world, published in the recently released State of the World Population Report 2013, titled ‘Motherhood in Childhood Facing the Challenge of Adolescent Pregnancy’.

Teenage pregnancy is a major development challenge with almost all (95 per cent) of the world’s births to teenage mothers occurring in developing countries. Each year in the developing countries, seven million girls under the age of 18 give birth. Two million of these births are to girls under 15.

According to the Motherhood in Childhood report, more than 60 per cent of these adolescents who wish to avoid pregnancy are unable to access modern contraception. Instead most rely on ineffective traditional methods. 

Even where girls are willing to prevent pregnancy, laws and social norms prevent girls from accessing contraception. Many times the adolescent girls are unable to make decisions on their reproductive health. Take for example, 16-year-old Whitney’s story:

“I went to a hotel where I met my boyfriend. He told me ‘let’s have sex without a condom.’ I told him ‘no, with condom.’ He said ‘if you get pregnant, I will take care of the child,’ and that is how I got this girl.”

According to the report young people are seldom prepared for their sexual and reproductive lives and this exposes them to forced sex, abuse and exploitation. 

For those who are married, and this is one in three girls under the age of 18 in developing countries, only 23 per cent are using a contraception method with an unmet need for contraception of 23 per cent. Within this group, a World Health Organization found that most births to teenagers are “intended.”

But there are many other teenage mothers who never intended to get pregnant.

Léocadie, 16, from Burundi got pregnant after rape. Her story is also published in the report which quotes her as saying:

“…I was in the first year of junior high when it happened. One night, I went to fetch water…he took me… he raped me. I was scared, but I was still a kid of 15, I could not think or imagine that I was going to get pregnant. I knew it after.” 

For 16-year-old Chada from the Democratic Republic of the Congo, poverty at home made her vulnerable. At 14 she dropped out of school because her family did not have money to pay her school fees. 

“My mother used to send my sister and me to the market to beg for something to bring home to eat. One day, we begged two gentlemen for some money. They gave 2,000 Congolese Francs [about $2] to my sister to buy food to take home. Once my sister left, they took me to a pub and bought me a sweet drink, but it had something in it that put me to sleep. I woke up in a health center, where nurses told me that I had been raped. I became pregnant,” she told UNFPA.

For girls like Whitney, Leocadie and Chada the report recommends availability and access to emergency contraception, which can prevent pregnancy by up to 90 per cent within five days of unprotected intercourse.

Health implications of teenage pregnancy

According to WHO, teenage pregnancy presents serious consequences for the health of the girl and her baby especially in weak health systems. 

Due to stigma associated with teenage pregnancy, girls are less likely than adults to seek skilled care before, during and after childbirth.

Teenage girls are also at risk of prolonged obstructed labour. Where they cannot access emergency caesarean section services to save them and their babies, they end up with obstetric fistula and many times lose their babies if they themselves survive.

Babies to teenagers have a 50 per cent higher chance of being born dead or dying at birth compared to those born to mothers aged 20-29 years.  Teenage mothers’ babies are also more likely to have low birth weight, which can have a long-term impact on their health and development.

During pregnancy, teenage girls are prone to unsafe abortion. Every year about three million unsafe abortions occur globally among girls aged 15-19 years.  Death from abortions constitute 13% of maternal deaths globally but up to 18% for the East African sub region.

The report, highlights as one of the success stories, Ukraine’s ‘Reproductive Health of the Nation’ programme which has decreased abortions by more than 80 per cent. In the early 1990s, there were one million abortions reported each year in Ukraine. This has been achieved by mainly increasing access to contraceptives and family planning information and services.

Young people and development

A UNFPA media advisory ahead of the Third International Conference in Addis Ababa this week states that reproductive choices are the key to ensuring that the young generation will have a future “When a girl becomes pregnant, her present and future radically change—rarely for the better,” it states.

More than 40 per cent of the world’s population is under age 25. In Uganda, one of the countries with the highest population growth rate, adolescents aged 10-19 constitute twenty-four percent of the population translating to 8,326,000 adolescents. 

According to the Population Reference Bureau, nearly one in three people living in Sub-Saharan Africa, is between the ages of 10 and 24, translating to about 297 million young people. This age group is expected to double by 2050. 

 “Young people are key to development, but they will only be able to fully contribute to their communities if they can realize their right to make choices related to their reproductive life. If they are able to avoid adolescent pregnancy and stay longer in school, they will have better prospects and more opportunities. That is the real wealth of a nation,” said Dr. Babatunde Osotimehin, Executive Director of UNFPA in release ahead of the ICFP conference.

This is against the background that though there is evidence to commitment to eradicate poverty, African governments are not adequately investing in girls’ human capital development in especially education and health.

A World Bank report, for example reveals that 85 per cent of secondary school-aged girls in Uganda are not in school. This is despite the universal primary and secondary education programme.

The Motherhood in Childhood report states that less than two cents of every dollar spent on international development is directed specifically toward adolescent girls.

Benefits of girl education 

Education is critical to improving sexual and reproductive health outcomes among women. The longer girls stay in school, the more likely they are to use contraception and prevent pregnancy and the less likely they are to marry young. 

Girls who are not in school are more likely to get pregnant than those in school, whether or not they are married.

When a girl stays in school and gets an education, especially during adolescence, she is more likely to avoid child marriage and delay childbearing reducing risk or infection like HIV. 

There are economic benefits as well. When girls complete secondary school, they have greater prospects of gainful employment. Also girls who complete secondary education receive substantially higher returns in the workplace than boys when both complete secondary school.

Educated girls are exposed to more opportunities outside the traditional household roles improving not only the family but their communities’ development as well.

The flip side is that when girls get pregnant, they drop out of school or when girls drop out of school, they are more likely to get pregnant,  exposing them to a life cycle of poverty.

A World Bank study found that the lifetime opportunity cost related to adolescent pregnancy—measured by the mother’s foregone annual income over her lifetime—ranges from 1 per cent of annual GDP in China to 30 per cent of annual GDP in Uganda. 

 “What is needed is a new way of thinking about the challenge of adolescent pregnancy. Instead of viewing the girl as the problem and changing her behaviour as the solution, governments, communities, families and schools should see poverty, gender inequality, discrimination, lack of access to services, and negative views about girls and women as the real challenges, and the pursuit of social justice, equitable development and the empowerment of girls as the true pathway to fewer adolescent pregnancies,” Dr Osotimehin states in the foreword to the Motherhood in Childhood report.  

Some countries have been successful in addressing the needs of teenage girls. The report highlights Netherlands as one of the countries with very low levels of adolescent pregnancy and lowest levels of abortion worldwide which it realised by promoting universal and comprehensive sexuality education and contraceptive use.

In Sub-Saharan Africa, between 2005 and 2011, Ethiopia doubled the number of women with access to contraceptives and reduced unintended pregnancies, unsafe abortions and maternal and child mortality. 

 Ethiopia is hosting the Third ICFP conference. Expanding family planning access for young people will be a central theme at the conference in Addis Ababa this week. 

The conference will bring  together global leaders and advocates in the spheres of politics, science, health care as well as youth leaders to discuss and bring attention to the benefits of Family Planning and child spacing.  

The conference will also discuss adolescent pregnancy and showcase new thinking in tackling the problem. In the meantime, Swinton from Zimbabwe who got pregnant at 15 captured many teenage mothers’ desires:

“I am always imagining what my life would be like if I had met someone before I was pregnant, someone who taught me to be assertive, someone who talked to me about relationships, the advantages and disadvantages of engaging in sex so young. Maybe I would not be in this situation.”

Will today’s generation of leaders deliver for the vulnerable girls in developing countries? Only posterity will tell.