Unplanned: A large number of teenagers fall pregnant and health services are being blamed. But is this the cause?
BODY LANGUAGE
Youth is thought of as a period of optimum health, but many initiatives to ensure young people’s sexual and reproductive health, including the prevention of pregnancy and sexually transmitted infections (STIs), have not been successful.
This is reflected in the high number of teenage pregnancies and people contracting STIs. Although the latest statistics show that there has been a decline in teenage pregnancy over the past two decades, the number of young people falling pregnant is still shocking. Teenage pregnancy remains a major social and health problem.
The prevalence of teenage pregnancy is problematic mainly because HIV prevalence is high. In addition, pregnant teenagers face serious health, socioeconomic and educational challenges.
It is surprising that even with laws that seek to protect girls who fall pregnant while still at school there are schools that are still hell-bent on kicking out learners who fall pregnant. The DM Motsaosele Secondary School in Emalahleni, Mpumalanga, has issued pregnancy commitment forms to girls to sign in which they have to declare that they will not fall pregnant and that if they do they will be kicked out of the school.
Does the school have a strategy to educate young learners about sexual and reproductive health? It is evident that the school is aware that learners are sexually active, but strips itself of all responsibility should they fall pregnant.
We need to ask ourselves why so many young people are falling pregnant when access to health is free and when they have multiple contraceptives choices.
Although there have been strides in improving primary healthcare and access to it in South Africa and the continent, it seems these developments have not met the needs of the younger generation. This also means efforts to curb the HIV epidemic, such as condom distribution, are not working effectively. It also means more young people are at a high risk of acquiring STIs.
It is important to understand and address these challenges, with the hope that such an understanding might inform future research, practice and policy about interventions that address young people’s unique barriers to accessing healthcare.
The majority of young people still find it hard to accept the methods and approaches used in many health centres, leading to a decline in the number of people who use sexual and reproductive health services.
The matter of real and perceived barriers that prevent access to healthcare are well documented. A study in 2016 by Anna Newton-Levinson, of Emory University in Atlanta, United States, found the biggest barriers in low- and middle-income countries were related to the acceptability of the services offered.
Young people need services that are designed specifically to meet their needs.
A study conducted in Soweto by Kelsey Holt and others in 2012 found that healthcare workers’ opinions about sexual and reproductive health issues affect young women’s ability to access these services. Similarly, Magdalena Richter and Vivian Mfolo and Rebecca Geary and others assert in their reports that many of the South African public health facilities fail to provide youth-friendly health services.
It is well known that many people who use healthcare have issues with the approach of healthcare workers. Sufficient data exists to show that their attitudes towards patients lead to a decline in people using healthcare.
Although youth-friendly services are being set up around South Africa, we are still battling with equitable, feasible and effective factors that hinder access to healthcare for young people.
Doortje Braeken and Ilka Rondinelli, in a 2012 report, echo this when they say: “Although it may seem obvious, it is important to remember that despite how friendly a service may be, or how friendly the staff are, services cannot be considered ‘youth friendly’ if young people are not actually using them.”
If adolescents are expected to use sexual and reproductive health services, it is essential that we understand the developmental, contextual and relationship variables that may influence their use and the acceptability of the healthcare provided.
The availability, accessibility and acceptability of healthcare services for young women significantly affects their use of prevention methods.
Tsidiso Tolla is a master’s student of public health at the University of Cape Town