Unplanned teenage pregnancies often feature in South African news and debates. Far too often, however, the discussions are moralising and unhelpful. As South Africans, we should not be responding to unplanned pregnancies by stigmatising teenage sexuality or blaming these mothers.
Nonetheless, we need to help teenagers to decrease unplanned pregnancies, to realise their rights to sexual and reproductive autonomy, and to make wise decisions about when, with who and how to safely have sex.
South Africa has a staggeringly high number of unplanned teenage pregnancies. About one in three teenage girls report having "ever been pregnant", the majority, unplanned. (see sidebar)
Alarmingly, a 2012 survey by the Human Sciences Research Council found that 5.2% of teenage girls between 15 and 19 were infected with HIV.
Falling pregnant has a devastating effect on teenage girls' schooling, with consequent negative impacts on their, and their child's, future.
Only a third remain in school during their pregnancy and return after childbirth. Interestingly, the highest return and completion rate is among girls who fall pregnant and/or give birth while in grade 12.
If a teenage girl falls pregnant, government and society have a legal and moral obligation to support her to remain in school and return after she gives birth. Schooling is her right and will determine her and her child's future.
The South African Schools Act (1996) permits pregnant teenagers and teenage mothers to stay in school while pregnant and to return after childbirth. But the government and the schools are failing to assist girls to realise this right.
Get them back in school
Supporting teenage mothers to complete their education is the most powerful intervention we as society can make for both the teenage girl and her child.
The review found that the single most important factor for determining whether a teenage mother would return to school was whether she had family support (in particular from her mother) to assist her with or pay for child-care.
Pregnant teenagers and teen mothers are often stigmatised at school by peers and teachers. Some reported being "strongly encouraged" to leave school once visibly pregnant.
This highlights a critical concern: what is the role of the school in supporting a teenage girl as both a learner and a mother? Childcare usually falls to the teenage mother (and her family), and not the father. Schools must become spaces that actively support teenage mothers, for example, providing more academic support when needed.
Schools should support a mother's right to exclusively breastfeed if she so chooses. Indeed, the South African department of health advocates exclusive breastfeeding, and we know young mothers need to return to school soon to increase their chances of educational success – these two desires need not be mutually exclusive. A simple intervention could ensure that all high schools have a crèche located on the premises or very near – so both learners and teachers' babies could be breastfed during breaks.
We need to provide teenagers with:
- information about their sexuality, reproductive health and rights;
- appropriate and acceptable family planning options;
- non-judgemental access to comprehensive termination of pregnancy services; and/or
- clinics staffed by compassionate health care workers.
The new contraceptive implant, Implanon, announced by Health Minister Aaron Motsoaledi, provides another option for teenage girls. It has two significant benefits: it remains effective for up to three years, removing the need for regular clinic visits or a daily pill, and should be available for free in all public health facilities by June.
However, it will not provide a magic panacea for unplanned pregnancies. The lack of access to contraceptives is but one reason girls fall pregnant – other reasons include whether she knows about it, whether she can get to a clinic, whether the implant is available, whether nurses offer it, and the ways in which poverty and inequality limit her ability to access it.
Furthermore, Implanon does not protect from HIV infection – teenagers must still use dual protection to avoid HIV.
At the same time, we need to recognise that most teenage girls are neither victims nor irresponsible, and they need to be involved in planning responses, rather than ostracised.
We need to change the structures, context, spaces and communities in which teenagers live. We need to support teenage girls to take charge of their sexuality and to have meaningful power over when, whether, with who and how they have sex.
We need to challenge the social norms that perpetuate notions that it's acceptable for men and boys to have significant influence over, if and how girls have sex – norms that legitimate and often hide forced sex and intimate partner violence.
Responses like these will enable teenage girls to take ownership of their bodies and their sexuality and will reduce unplanned teenage pregnancy and HIV.
Key drivers of teen pregnancy in South Africa
A recent review for the Ford Foundation and Partners in Sexual Health lists the key drivers of unplanned teenage pregnancy in South Africa:
- High levels of inequality between men and women, boys and girls, which leaves girls with very little power to negotiate sex and condom use.
- Poverty, which reinforces the above inequalities and drives transactional sex.
- Different and gendered expectations of how teenage boys and girls should act: sexual experimentation and even promiscuity is tolerated among boys and seen as part of becoming "a man", but girls should be "sexually naive'" and not carry condoms or "know" about sex.
- Limited knowledge about contraceptives, how to use condoms and the importance of being protected against both pregnancy and HIV, alongside inaccurate and inconsistent contraceptive use.
- Poor access to contraceptives and comprehensive termination of pregnancy services.
- Disapproving attitudes of many health care workers.
- High levels of gender-based violence.
- Poor sexuality education in our schools and communities, compounded by social taboos around sex and sexuality.
Samantha Willan is a Sexuality, Gender Equality and HIV Consultant and also Programme Manager of the Gender Equality and HIV Prevention Programme at Heard, or Health Economic and HIV/Aids Research Division, at the University of KwaZulu-Natal.