The holidays didn’t start well for Ainsley Robinson (not her real name). She was 14 years old and wanted to go out with her friends, but she was forced to help her mother in the small kitchen of her zinc shanty in Hopetown, in the province south african of the North Cape. There was tension between her and her mother due to her new boyfriend, an 18-year-old boy who had already finished school. While they were cutting vegetables for dinner, the mother noticed that the girl’s body had changed and her breasts seemed swollen. The next day he took her to a clinic, where nurses confirmed she was three months pregnant.
His mother was upset; I already knew too many teenage girls with children in Hopetown. Robinson was 15 when she gave birth in July last year. “They had to cut me in the hospital to deliver the baby, because it was too big,” says Robinson, referring to an episiotomy, a procedure in which doctors cut the area between the vagina and anus to create a larger space. through which the baby can come out.
Robinson is one of about 365 teenagers who give birth every day in South Africa, according to the Health Barometer figures by District 2022/23. Of that daily number of births, 10 correspond to girls who have not yet turned 15 years old.
The World Health Organization (WHO) examines a country’s teenage pregnancy rate (that is, the number of girls aged 10 to 19 who give birth out of the total number of girls in that age group) to check the effectiveness of a Government’s health care. Although birth rates among teenage girls around the world have fallen since 2000, last year there were still around 1.5 births per 1,000 girls aged 10 to 14. According to a study published in 2022 in the magazine South African Medical JournalSouth Africa had the same rate in 2020 for this age group, but it was almost 50% higher than in 2017, and the authors estimated it would increase to 1.6 the following year. However, it is lower than the rate of 4.4 per 1,000 girls seen in the rest of Africa. According to Peter Barron, a public health advisor, and his co-authors on that study, the numbers are “very high” compared to what is seen in developed countries.
Many young mothers in South Africa also have HIV: around one in five of women aged 15 to 24 who have recently had a baby
A high number of early pregnancies is bad news for a country’s development prospects, because having a child in adolescence usually means that the mother has to drop out of school. A vicious circle begins: not being able to finish school reduces her chances of continuing to study or getting a job, which means she has to depend on a government subsidy to care for her child, and she and her children will continue to live. in poverty. What’s more, many young mothers in South Africa also have HIV (about one in five among women aged 15 to 24 who have recently had a baby, according to data from the Human Sciences Research Council). “Any girl who gets pregnant in that age group (10-14 years) is a train wreck, because it is likely due to non-consensual sexual relations, i.e. rape,” Barron says.
Although the teenage motherhood rate in South Africa in 2022 was 5% lower than the previous year, the figure had continued to increase at a rate of 1.5% annually for the previous four years. “Look at what’s happening in the United States,” Barron continues. “Year after year, for 30 years, the rate of early pregnancies has been decreasing. “Ideally, that is what we would like to see in a developing society, because as people’s educational and economic prospects improve, the likelihood of them becoming pregnant at a young age decreases.”
In South Africa, for example, Gauteng and the Western Cape, the only two provinces where the proportion of teenage mothers is well below the national figure, are also those with the lowest poverty rates (around 30%).
Parents and teachers do not usually talk about sex and sexuality with them because they consider them ‘girls’.
Zozo Nene, President of the College of Obstetricians and Gynecologists of South Africa
Zozo Nene, president of the College of Obstetricians and Gynecologists of South Africa, says that in the Eastern Cape and Northern Cape, adolescent girls also struggle to access services such as contraceptives and abortions, and there is a lack of adequate sexuality education. “They are not mature enough to understand the consequences of having sexual relations. Parents and teachers do not usually talk about sexuality with them because they consider them ‘girls’. They may hide the pregnancy, at first because they don’t know what missing menstruation means, and later out of shame. This leaves them alone,” he explains. Additionally, they also often start prenatal care late, if at all.
Education and access to contraceptives
The authors of the District Health Barometer say that it is necessary to better prepare adolescents for life, that is, help them understand what an abusive relationship is, why it is important to have safe sex, as well as ensure that they can obtain condoms and contraceptives without stigma.
Although there are still regulatory hurdles to overcome before the daily contraceptive pill can be dispensed through machines, a self-help system like this could be part of the solution to the need for family planning in South Africa, it has emerged in a presentation at the International AIDS Society conference held in Munich in July. When cases of early birth are decreasing, it is because everyone – from government, academia and health workers to NGOs, religious groups and the private sector – takes responsibility for making things change. Nene states.
The girls don’t realize what they are giving up. They almost take pregnancy and childbirth for granted
Pamela Jaquire, teacher who became a mother at 17
The professional body that oversees the specialist training of obstetricians and gynecologists in South Africa will visit all nine provinces to train health workers on how to help adolescent girls obtain contraceptives and respectful care. “As health professionals, we care for these adolescents when they are already pregnant. I wish we could change this, that we intervene before they get pregnant.” To do this, she believes, adolescents must be able to make informed decisions about their reproductive needs. “As long as healthcare professionals continue to make decisions for young people rather than letting them take responsibility for their own lives, we are unlikely to gain acceptance.”
In the end, things worked out well for Robinson, the Hopetown teenager. She returned to school after her baby was born and will finish eighth grade this year. She is lucky to have found the support of one of her teachers, Pamela Jaquire, who knows perfectly well how a surprise pregnancy can alter a young woman’s life. “I was 17 when I got pregnant,” she explains. “I was thinking of going abroad after my studies, but suddenly I found myself at an academic disadvantage.” Today, as a teacher, she wants to help the young women in her care understand the challenges of early pregnancy. “Girls don’t realize what they’re giving up. They almost take pregnancy and childbirth for granted. What bothers me about Hopetown is that when I talk to parents, it has become normal to them.”
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