Adolescent pregnancies are often unplanned and may have long-term health and economic consequences for young mothers. This is particularly true in developing countries, where teenage fertility rates tend to be higher and social infrastructure is generally weaker. Studies note that women who give birth during adolescence are less likely to complete formal education, hindering their ability to earn stable income. The health effects are also dangerous, as young mothers often face higher rates of maternal and foetal mortality. EBR’s adjunct writer Meseret Mamo spoke to those involved with the issue as well as consulted research to learn more about the intricacies of this issue and what’s being done to mitigate its potentially problematic consequences in Ethiopia.
Eskedar Dereje was under the age of 18 when she suddenly found herself pregnant with a child she wasn’t ready to raise. She conceived the baby accidentally, when she had intercourse with a man she met through her friend.
Even though she was sexually active and used contraceptive pills with her boyfriend, she didn’t use them the day she had sex with a new man. The moment she learnt about her pregnancy, she tried to terminate it. However, her lack of knowledge that she could get the service in a hospital means her efforts to find a safe place were futile. Now, she is raising her six-month-old baby boy and had to drop out of school. She now depends on her mother, who also has a child to care for. Together, the family lives in a small house in the slums of Amist Kilo in Addis Ababa.
Eskedar’s story is a common feature of some developing countries, where economic opportunities are especially limited for women. Since it is often unplanned, pregnancy may bring certain challenges for teenage mothers, whose education and potential career plans are thrown into disarray, hindering their ability to gain financial independence.
Despite the unintended consequences of adolescent pregnancy, it is relatively common in Ethiopia. The 2014 Mini Demographic and Health Survey published by the Central Statistical Agency (CSA), which presents the age-specific fertility rate for the country, shows that the national age-specific fertility rate of teenage women age 15-19 stood at 65 births per 1,000 women.
The urban-rural variation of teenage pregnancy is also striking. According to the same survey, although the fertility rate for teenage women stood at 3.7Pct in urban areas, in rural areas it is estimated to be 7.2Pct.
Other mini surveys conducted in various parts of the country demonstrate the ubiquity of teenage pregnancy. One survey shows that among sexually active students between the ages of 15 and 49, 50Pct of teenage girls had a history of pregnancy at least once in Kola Diba, a small town in the State of Amhara; 15Pct in Harar and 18Pct in Addis Ababa.
Sintayehu Abera, Maternal and Youth Health Team Leader at the Ministry of Health (MoH), says although some societal norms and religions condemn sexual intercourse between unmarried people, young people are under different influences and are exposed to having unsafe sex, which may result in unwanted pregnancy. “Even the physical and mental changes observed in this age group can be a factor,” he says.
The World Health Organisation defines the ages between 14 and 19 as the transition period from childhood to adulthood. This age group is characterised by significant physical, psychological, mental and social changes. These result in rapid endocrine production, including hormones that affect sex gland maturation and the production of sex steroids.
Teen pregnancy is an important issue for several reasons, especially in developing countries. According to a study entitled ‘Determinants of Adolescent Fertility in Ethiopia’ published by Save the Children UK, the country’s population will grow more rapidly when women have their first child as a teenager, as early initiation of pregnancy prolongs the reproductive period and subsequently increases fertility.
There are societal implications as well. The study argues “the strong association between adolescent childbearing and low levels of educational achievement may have a negative impact on their position and potential contribution to society. Individually, adolescent fertility is associated with adverse maternal and child health outcomes, including obstructed labo[u]r, low birth weight, f[o]etal growth retardation, and high infant and maternal mortality rate.”
The United Nations Fund of Population Activities reports that of the roughly 14 million babies born to teenage mothers each year, more than one million die before their first birthday – and more than 2 million suffer from chronic illnesses. Furthermore, their data also shows that an estimated 70,000 teens die each year during pregnancy and childbirth.
In addition to the health threats early pregnancy poses, there are also economic implications for young mothers. Data from The National Campaign to Prevent Teen and Unplanned Pregnancy, a Washington D.C.-based advocacy organisation, teenage pregnancy leads to significant increases in high school dropout rates, severely thwarts a mother’s ability to complete formal education and decreases overall earning potential, especially in the skilled labour sector. The lack of engagement in the formal, skilled labour sector has potentially adverse economic implications in the form of missed tax revenue.
These factors are exacerbated in countries where social assistance and welfare programmes are less developed, leaving young mothers with fewer options and less stable safety nets to support their family or get assistance if they hope to work or re-enrol in school.
The societal, economic and health risks associated with teenage pregnancy often place expectant mothers in a difficult situation: “Teenagers who are afraid to tell their parents that they are pregnant often grow desperate to end their pregnancies,” explains Sintayehu. “Such frustration leads to abortion.”
Prior to 2004, abortion was permitted in Ethiopia only to protect a woman’s health or save her life in dire situations. According to the revised penal code, which was adopted in 2004, abortions are also permitted when a pregnant woman lacks the capacity to care for a child because of her young age.
Stakeholders say the legalisation has less to do with encouraging teenage sex and more to do with the health and well-being of those seeking abortions. “We don’t encourage early age sexual intercourse but [it is important to] provide safe alternatives for the youths in case they start early age sexual intercourse and become pregnant,” says Sintayehu. “Before the revised law, one of the major causes for maternal mortality was connected to unsafe abortions, which accounted for 32Pct of maternal mortality.”
Tewodros Dawit, a senior researcher at the Ethiopian Justice and Legal System Research Institute, shares Sintayehu’s opinion. “Contrary to the larger societal norm and religious teachings, there is sexual intercourse among teenagers and protecting underage kids from having unwanted pregnancy and providing them with a safe alternative is the intention of the revised law,” he says. “People under the age of 18 are presumed to have a lesser ability to make a decision concerning any legal activity, so the law defends their interest under minority rights. Being pregnant in this age range is also usually unwanted, so forcing minors to have a child they didn’t prepare for has an adverse effect on their ability to have a career.”
However, Sintayehu still believes that there is an awareness gap regarding the existence of the revised law, like in the case of Eskedar. “I understand that many don’t know government health centres provide safe abortions,” he said. “In the 2015/16 fiscal year, of the total number of abortion cases, only 68Pct went through safe abortion services.”
At the national level, the total abortion rate stood at 13Pct. The State of Gambella has the highest rate, with 31Pct, while the State of Tigray has the lowest abortion rate, which is 7Pct. “The rate is significant,” says Sintayehu. “This means we have to work harder and have different strategies to address the problem of adolescent pregnancy.”
Yet, some stakeholders, especially administrators of education programmes that are working with the youth, argue that under the existence of the law, creating awareness among the youth about safe sex practices has become difficult.
“It is very challenging. We know there are students even in elementary school who are becoming sexually active, yet we can’t provide different family planning methods at the school level and demonstrate the use of it,” says Hirut Gebremichael, Gender Awareness Creation Coordinator at the Addis Ababa Education Bureau. “Since they consider abortion as an alternative, it is more difficult for them to listen to us and learn about family planning.”
Stakeholders stress that it is not only unplanned pregnancies and abortions that are a concern, but the possibility that some teenagers will treat the issue of safe sex and pregnancy nonchalantly because they view abortion as a final solution and therefore may be less diligent about practicing safe sex.
An employee at the Youth Centre of the Family Guidance Association of Ethiopia (FGAE), who spoke to EBR on the condition of anonymity, says that in the past a girl in her school uniform came in three times to get an abortion.
In order to empower teenagers to make wiser, safer decisions regarding their sexual health, the Education Bureau provides life skills trainings for students. “Developing their life skills and self-confidence is what we are doing in schools through youth peer discussions. We believe this is the first task,” stresses Hirut.
Although reproductive health education is within school curricula and the life skills training addresses different family planning methods and the consequences of having early sex, there are instances in which young people, even those in urban areas, are not properly informed. “I even meet teenagers who are unaware of their menstruation cycle,” says Anley Henok, HIV Programme Team leader at the FGAE.
The FGAE, which recently celebrated its 50-year anniversary, has 28 youth centres throughout the country. The Centres engage in awareness creation interventions about youth reproductive health and the use of different contraceptive methods; they also provide options for safe abortion in case of unwanted pregnancy.
Organisations like this are confronting the issue of unplanned pregnancy head-on by teaching young people about its realities. However, stakeholders say the best way to address the issue is to talk about sex education and family planning in an open, earnest manner at the familial level. Shying away from the subject, they stress, will only exacerbate the problem. EBR
4th Year • October 16 2016 – November 15 2016 • No. 44