It’s better to help rather than punish teen mothers

In her school uniform and sitting in a classroom with rows of wooden desks and blue plastic chairs, Otlotleng Moolikwe, 18, looks just like any other grade 12 learner. 

It’s hard to imagine she’s the mother of a four-year-old boy.

Moolikwe says she was 13 years old when she and her boyfriend first had sex. They were next-door neighbours and were both in grade 7.

They hadn’t planned on having sex that day, Moolikwe recounts. “It just happened.”

The two found themselves at home alone, and what started simply as making out quickly turned into clothes being shed.

They had had the abstinence talk — at home and at school — and also knew about using a condom.

But in the rushed reality that theoretical knowledge came to naught, Moolikwe says: “The condom slipped off during sex.”

Three months later — and after taking three pregnancy tests — Moolikwe had to accept that she was having a baby.

She recalls: “My mother noticed because she would buy me sanitary pads and then just see them in my wardrobe, unused.”

Let’s talk about sex

Moolikwe grew up in Majankeng, a rural part of North West, just under an hour’s drive from Potchefstroom.The road to her home — she lives with her parents, brother and cousin — leads past farms with cows, goats and chickens. 

Teen pregnancies are frowned upon here. But they happen.

There was a 25% increase in the number of girls aged 10 to 14 who gave birth in public healthcare facilities in North West from 2017 to 2021, according to an April study published in the South African Medical Journal (SAMJ).

Moolikwe shuffles on the blue plastic chair, staring at the cracks in the plaster of the classroom wall. A breeze blows through the open window, which looks out over a clump of trees and a nearby mountain.

“I knew there was a chance I could be pregnant. But still, when I found out, I was scared,” she says.

In Moolikwe’s community, the default approach to sex education is “just don’t have sex”.

But that approach isn’t working.

More than 80% of girls in rural KwaZulu-Natal had some sexual experience by the time they were 13 years old, a 2015 survey found. About one in five were having sex before the age of 15.

Sex itself is not the problem. The issue is rather that children are having sex without contraception. 

According to the 2016 Demographic and Health Survey, one in six teenage girls aged 15 to 19 years have had a child. In 2020, close to 34 000 births in South Africa were by mothers younger than 18 — and more than 600 of these mothers were 10 to 13 years old. 

The SAMJ study showed that nationally the number of births to girls aged 10 to 14 had increased by close to 50% from 2017 to 2021. For those aged 15 to 19, births increased by about 18%.

Teenage pregnancy can have serious health complications, such as the risk of developing high blood pressure that can cause seizures and young girls being more susceptible to bacterial infections that can enter the bloodstream and lead to death if not treated in time.

Also, because their bodies may not yet be fully developed, adolescent girls are more likely to have complications during labour and mothers aged 15 to 19 are twice as likely to die during childbirth than those who have babies in their twenties. 

A pregnancy at a young age can also be bad for the baby.

The foetus is likely to develop slower when the mother is in her teens and the baby could be born too early, which could increase the risk of the infant dying from complications such as its lungs not being fully developed.

But children often don’t know how to broach talking about sex and pregnancy, something Moolikwe experienced herself. Even when she was worried about the chance that she might be pregnant, she wasn’t sure how to bring up the taboo topic with her family.

She recalls: “I couldn’t talk to my parents. I always talked with my friend or my cousin. I’m more comfortable talking with them, because they always listen to me.”

The tangled relationship of teen pregnancy and school drop-outs

The worry about teen pregnancies is about more than health risks; it can also disrupt girls’ education and cause them to drop out of school. This can jeopardise their chances of finding a job later.

The 2019 National Income Dynamics Study noted that 3 449 youths who were unemployed and didn’t finish school. Of these, 81% were women. The most common reason for not looking for a job is because of responsibilities at home, and one in five said having a baby or being pregnant was the reason they stopped going to school.

“Pregnancy is both a cause and a consequence of school dropout,” the authors of a 2019 paper published in Health Education and Behaviour said.

The study found that girls who fell pregnant while still in school were twice as likely to drop  out than their peers who didn’t get pregnant. Similarly, learners who left school before completing their studies had a four times greater risk of falling pregnant than girls who stayed to finish school.

Given South Africa’s high teenage pregnancy rate and the disruptive effect on girls’ schooling, the basic education department introduced a new policy in December to help keep teenage mothers in school.

This document says all learners should have access to sex education and pregnant girls should be allowed to attend classes as long as they can and then be encouraged to come back after giving birth.

One plus one makes another one

But keeping pregnant people in school is an uphill battle.

In 2021, a rapid update of the earlier National Income Dynamics Study showed that compared with 2018, triple the number of students aged seven to 17 were no longer in school.

And although it doesn’t specify how teen pregnancies have been affected, a report by the South African Medical Research Council noted that teenage girls struggled to get contraceptives during Covid-19 lockdowns, which, they say, could be part of the reason for the rise in teen pregnancies during the first year of the pandemic. 

That’s a pattern also seen at Matsukubyane Secondary School, which Moolikwe attends. 

Tinyiko Rakobela, of the HIV prevention organisation Show Me Your Number, has been working with learners at Matsukubyane school since 2019. In the past year there have been 16 pregnancies at the school (the school has 1 018 learners), a spike since learners started returning after lockdown. Typically, the school saw only one or two pregnancies a year, she says.

“During Covid, kids were at home most of the day, so they had lots of free time and little supervision,” explains Rakobela.

She says their organisation helps with clinic referrals, offers financial assistance and creates a space for young mothers when they need to talk. She helps to answer questions about their relationships and sex, what type of protection to use, where to get contraceptives and how giving consent to sex works.

Moolikwe says: “Without the support of my friends at school and my family, I’m not sure I would have stayed in school.”

She speaks to Rakobela about her relationship with her boyfriend or problems at home, but she also relies on the network of other teen mothers at the school.

Moolikwe says: “We can support each other. The others will always come to me and ask me about what kind of things they should be doing when their child is crying.”

Parental guidance advised

When Moolikwe gets home from school, she is greeted by her mother, who takes care of her son. He’s across the street spending the afternoon with his father and paternal grandparents.

When he returns, he heads straight for the floral couch and his grandmother immediately pulls him onto her lap.

Moolikwe is preparing to apply to university and is doubling down on studying. 

Her biggest help? Her mother.

“My parents insisted that they would look after the baby so that I could finish school,” she says. “Dropping out was not an option.”

But many girls don’t have a good support system.

Even though the law protects girls’ right to remain in school while pregnant and after giving birth, schools are not obliged to go to extra lengths to make that happen.  

A 2013 report for Partners in Sexual Health, an NGO focused on sexual and reproductive rights, outlines how implementing policies meant to protect girls is “filtered through people’s own views on teenage sexuality, and beliefs about ‘appropriate girls and boys norms’ — and this has led to many violations of these policies”.

So although girls are not being expelled, the stigma linked sex and pressure to hide the pregnancy force many to drop out.

And it’s not only school staff members who have to come around. 

Says Moolikwe: “I thought that in school children will not judge each other. I thought they’ll just know that we can fall pregnant. But every time when there’s a girl who’s pregnant, they judge her — and most of the time it’s the girls. Sometimes I tell them that you may be judging her today, but tomorrow it could be you.”

That’s why creating a culture of support, both at home and in schools, is an important part of helping young girls stay in class. Parents can be an important link in this system, says Réjane Woodroffe, director of the Bulungula Incubator, an NGO that works to improve living conditions in the rural Eastern Cape. 

Part of their strategy is having zero tolerance for dropping out — not just specific to teen pregnancies — and helping learners to return to school.

Girls who have the backing of their mothers are more likely both to return to school and to complete their studies. Having a parent at home can also help relieve the pressure on the teen mother, who has to study while looking after the baby.

Moolikwe explains: “I’m not the one who raised my child. He was raised by my parents … Sometimes my parents will tell me: ‘This is not your child; this is our last born. So you don’t have to stress yourself.’”

It’s cool to stay in school

During the last few months of her pregnancy, Moolikwe’s world began to narrow down to her home. As her due date drew closer, she wasn’t able to attend class in person. 

A 2021 report from the Zero Dropout campaign explains that pregnancy can interfere with a teenage girl’s education even before the baby is born. Young women have to take time off both before and after giving birth and also need to go for regular clinic check-ups. 

The more times a learner misses school, the harder it becomes to continue studying and catch up. A 2012 study from Cape Town found that teen mothers were likely to lag behind their non-pregnant peers by more than half a year.

To undo this pattern “you have to support the school as well as the young women”, says  Woodroffe.

Rather than just introducing a policy that says girls must be allowed to remain in school while pregnant, training should be available to teachers to help them get on board with this decision, she explains.

Woodroffe says some teachers are worried that by accommodating expecting mothers “you’re encouraging young women to fall pregnant while still in school and that this sends a negative message to other learners”. 

Schools also need support in handling potential emergencies and health problems pregnant learners face. For example, if a girl were to give birth while at school, there should be a plan for getting her to a healthcare facility and keeping her safe.

But these strategies can’t be left just to the school — it should be a team effort between the school, the learner and her family, Woofroffe says.

During the later stages of school pregnancies, the Incubator has family members accompany girls all day in case they go into labour — specifically because there are no hospitals near the rural school or an ambulance service in the area.

“But it does place a burden on the girl’s family, as they have to sacrifice their time to be with her,” says Woodroffe.

She and her team try to keep teen mothers in class for as long as possible, because studying at home isn’t always possible. In the part of the Eastern Cape where she works — the Elliotdale district — online study “isn’t really an option”, explains Woodroffe.

“We don’t even have electricity. You have to find a way to charge the device and even if a learner has a cellphone, there isn’t a signal everywhere.”

Woodroffe realised that distance learning was possible if it could be done with textbooks and worksheets.

Moolikwe’s school took a similar approach.

“After school, my friend used to bring me books and assignments,” she says. “My mother used to take me to school so I could write my exams and then bring me back home afterwards.”

This support and hands-on help from her teachers allowed Moolikwe to stay on top of her classwork.

She was considering taking a gap year after matriculating but her father put his foot down.

She smiles: “He said no child of his will take a gap year. ‘You’re going to varsity.’”

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

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Aisha Abdool Karim
Aisha Abdool Karim is a senior health reporter at Bhekisisa.

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