Popular belief about rising rates of teen pregnancy in South Africa is not supported by statistics gathered over the past two decades.
Fertility rates among 15- to 19-year-olds have declined steadily from 124 births per 1000 women in 1987 to 1989 to 81 in 1998 and 54 by 2003.
Professor Rachel Jewkes from the Medical Research Council, in her keynote address at the Fifth Youth Policy Initiative round table on teen pregnancy, questioned the notion of an epidemic.
Policies introduced since 1994 to increase young people’s access to information and family planning services – both contraception and termination of pregnancy – have been largely effective.
In the face of widespread disapproval and stigma, families generally tend to support young mothers in caring for their babies and to allow them to return to school. But Jewkes cautioned that rates are still too high and to prevent an upsurge we need to acknowledge that teen pregnancy is a deeply rooted and problematic social phenomenon.
The majority of teen pregnancies are unplanned and unwanted. Of course, once a baby is born, most mothers rapidly develop deep affection for their children.
Dr David Harrison, CEO of loveLife and a discussant at the round table, focused on the need to address the social drivers of teen pregnancy.
He pointed out that it was popularly believed that schoolgirls were falling pregnant, but girls aged 15 to 16 years accounted for only a small percentage (7%) of teen pregnancy.
Most teen pregnancy (93%) occurs among 17- to 19-year-olds. Although some girls drop out of school because of pregnancy most, in fact, fall pregnant once they have dropped out of school.
Girls aged 15 to 19 years and 20 to 24 years are having sex at virtually the same rate; yet the spike in pregnancy and HIV between the two age groups is significant and strongly associated with school leaving.
School girls are able to protect themselves from pregnancy and HIV by engaging in protected sex, but subsequent life changes – most likely social and economic pressures – put them at risk for having unprotected sex.
While effort is required to consolidate and strengthen the gains in teen pregnancy achieved through biological interventions – providing youth-friendly family planning services to all teenagers without judgement and providing sex education in a timely manner – more effort is needed to address the social factors underpinning teen pregnancy.
Young men and women receive mixed messages about sexuality. On the one hand, teen sexuality is flaunted in the media and celebrated culturally; on the other, girls are chided when they fall pregnant.
Similarly, fathering a child is considered an expression of masculinity, but this is not accompanied by responsibility for the social or economic welfare of children.
Gender imbalances in South Africa mean that young women are often subjected to control by men through sexual coercion and violence – known risk factors for teen-pregnancy.
The intergenerational effects of early pregnancy are profound; absence of fathers from the home increases the risk of teen pregnancy and daughters of teen mums often have early pregnancies themselves.
Yet this can be turned around. When parents are involved in helping children negotiate their sexuality, the chances of early pregnancy are lowered. But young people interviewed for the round table indicated that parents struggle to talk about sex – ironically, though, it may be one of the most effective preventive strategies we have available to us.
Young people in South Africa demonstrate that they can exercise agency – choices about their sexuality – while they have hope and when they can access services.
Youth from better socio-economic backgrounds are better able to receive quality contraceptive and abortion services. But more than that, the scope of opportunities available to them increases their future aspirations and motivation to prevent unwanted pregnancy.
Similarly, lower educational attainment increases the vulnerability of young people to drop out of school and, when they have to, forgo choices and fall pregnant. Poverty is disempowering, not only by limiting educational, economic life opportunities but also lowering the motivation to protect oneself against pregnancy and HIV. Despite these differences, two-thirds of young people report that early pregnancy is unwanted.
The round table concluded that a suite of interventions is required to offer good first chances and preventative action. We know that schooling is protective against pregnancy, HIV and many other social and health concerns.
We must institute steps to keep girls in school for as long as possible and, when they do drop out, we must make available alternative pathways to complete education and to develop sustainable livelihoods.
But one of the most effective prophylaxes we can offer to young women is to increase their hope for the future – for education, for a job and for life. When pregnancies have occurred, a support structure is needed to offer second chances to teen mums.
A hard fight was won to ensure that South Africa’s educational policy allowed girls to return to school following a pregnancy. This must not change. Education is a critical tool to navigate economic and life opportunities. Young women also need the support of their families, and especially of the fathers of their children.
The discourse of promoting gender equality in the country needs to address the shared role and responsibility of men in sexuality, pregnancy and caring both financially and emotionally for children.
Moreover, research indicates that becoming a father can be turned into an opportunity for young men to choose responsibility over Âviolence and other high-risk life circumstances. Taking responsibility for someone who loves us and depends on us is good for everyone.
Teenage pregnancy is impacted on by a combination of health, social, educational and economic factors. Interventions in these areas – to promote access to health services, gender equity, schooling and economic opportunities – will have knock-on effects on teen pregnancy. But we must also be mindful of vulnerable groups most at risk for teen pregnancy: young people who have been sexually abused during childhood, those exposed to severe trauma, those with learning difficulties and other impediments to progressing smoothly through school and those young people living in extreme poverty.
The round table concluded that much has been achieved in providing services, particularly related to reproductive health. But this is not enough. To turn the tide on teen pregnancy and on the other health, social and economic challenges facing young people, provision of services must be equally matched by demand.
The youth sector and civil society must be encouraged and supported to hold government accountable for delivering high-quality services in an integrated and coordinated manner that reach sufficient scale to have a tangible impact.
Dr Saadhna Panday and Dr Monde Makiwane are part of the Human Sciences Research Council’s Youth Policy Initiative team focusing on child, youth, family and social Âdevelopment.