Lizeka Mda finds a surprising amount of ignorance about anatomy and reproduction among urban teenagers
Lindiwe Mthelezulu is writing matric this year. She cuts a very confident figure as she glides through the Carlton Centre, the playground for youth in Johannesburg. When a man sniggers about the length of her shorts to his friend, she stops mid-stride and gives him a bit of her mind about his comments, and bozos like him generally. There is no doubt that this young woman has her programme together.
Until she talks about sexuality. Mthelezulu says she knows all about that from a sex education class two years ago, and magazines. The condom is her contraceptive of choice though she would like to know more about injectables. There’s just one question she would like an answer to: why does one not get pregnant from oral sex?
In the Carlton Centre, 100m away, is the Planned Parenthood Association’s Youth Information Centre, where Mthelezulu could find answers to all her questions, but it has not occurred to her to go there.
At the centre Sipho Dayel, the association’s programme manager in Gauteng, does not find her question strange. “Many people believe a child grows in the stomach, so talk about wombs and the reproductive system is confusing to them,” he says. “And then religious beliefs confuse the issue more. When some people say children are a gift from God, they mean that literally. To them fertilisation has little to do with pregnancy.”
Reproductive health workers talk of ignorance about anatomy and physiology among young and old, educated and uneducated, as the biggest threat to HIV and Aids awareness.
“In many cases the reproduction students are taught is that of rabbits and frogs,” says Aloma Foster, the association’s national life skills co-ordinator. “What teenagers know about sexuality is what they learn from their peers, or television. They spend a lot of time watching soap operas where sex outside marriage is glamorised and condom use is not promoted.”
At a time when HIV and Aids constitute a great threat to South African society, the Department of Health, in collaboration with the Department of Education, has started to implement some prevention strategies.
Last year the Department of Education put out a tender for the training of teachers and nurses to provide sexuality education in high schools in the broader context of life skills training and getting Curriculum 2005 going.
The association won the tender in the Northern Province, the Northern Cape, Mpumalanga, Free State and Eastern Cape. In the other four provinces, the association got the tender in a consortium with other non-governmental organisations.
The training focuses on clarifying values, basic anatomy and physiology, decision- making, responsible behaviour, self-esteem and negotiating safe sex. It also provides education about sexually transmitted diseases, contraceptives, HIV and Aids, and substance abuse.
Foster says the major hurdles are that the training is value laden, and some teachers and nurses are not nearly as comfortable with their bodies as the trainers would like them to be. The teachers, many of whom are guidance teachers, are selected by the schools.
“Trainees have to deal with issues like homosexuality, masturbation and abortion. Some teachers have walked out of training. There are those who are not even open to discussing gender sensitive issues.”
But on the whole she says the teachers’ response has been positive. The training programme should have finished by the end of October but the education in high schools will only begin next year.
It may take years before it shows any impact on the behaviour of young people. Perhaps it will speed the decline of teenage pregnancies, particularly in provinces like KwaZulu-Natal and Northern Province, where the incidence of HIV and teenage pregnancies is supposed to be highest. But no one knows for sure if national teenage pregnancies are high enough to constitute a problem.
When abortion was legalised in February, it was expected that teenagers would be the primary users of this service. Yet the Reproductive Rights Alliance has published research that shows that of the 12 887 legal abortions for the six months to July, most (82,6%) were requested by women over 18.
The explanation for this contradiction could lie in the fact that not all of those who request abortions get them. Certainly facilities in Gauteng are overloaded as women who cannot access the service in their provinces go there.
Another explanation, say health workers, could be that pregnant teenagers go to clinics very late to access antenatal or abortion services.
“A lot of young people do not want to admit that they are sexually active,” says Pebetse Maleka of the Youth Information Centre. “They convince themselves that having sex once does not mean that they are sexually active. Teenagers are still being told at home and in church not to have sex. That’s what promotes their defensive attitude and why many don’t use contraception.
“Many of them know about the risks of HIV and Aids. Knowing about the risk is one thing, but it is not helpful if one does not know how to be assertive and insist on condom use.”
Motsumi Senne, of the Gauteng Subdirectorate for Youth and School Health Services, says his department plans to open Youth Drop In centres next year where young people can get information on anything. Nurses are being especially trained to be youth friendly.
But he does not hold much hope that this will stop teenagers from having unprotected sex.
The department is trying to persuade the national Department of Education to keep school doors open to pregnant youths. But he accepts that opposition to that may come from teachers and parents.
“No matter how good our services are, there are teenagers who will still take risks. But there is no point in ostracising them and allowing their lives to be ruined.”