By Dr Mildred T. Mushunje
Adolescents’ sexual and reproductive health matters, and their lives matter!!
Adolescents and young people constitute the bulge of population in the Sub-Saharan region, Zimbabwe in particular. An adolescent is any persons aged between 10 and 19 years. Very young adolescents are defined as those aged between 10 and 14 years and older adolescents as those aged between 15 and 19 years[1]. Investing in their good health and well-being increases their chances for better and more productive adult lives (SRHR Africa Trust, SAT, 2021[2]) yet they remain at a very high risk of unintended pregnancies. Zimbabwe is one of the countries with high cases of unintended pregnancies especially amongst adolescent girls and young women (AGYW). Poor access to comprehensive Sexual reproductive health and rights (SRHR) services is a key factor in unplanned pregnancies amongst adolescents, and this often leads to unsafe abortions which is one of the contributory factors to adolescent mortality (ZDHS, 2015), and unsafe abortion contributes about 5% to maternal deaths (Ministry of Health, 2015). Abortion in Zimbabwe is a public health and human rights issue which remains highly stigmatised regardless of advocacy efforts to liberalise it.
Zimbabwe has one of the highest cases of unintended pregnancies among adolescent girls. Girls becoming pregnant are often forced into marriage as it is generally taboo for girls to have children and not be married. A 2018 Amnesty International study[3] showed the impact of “out of pocket” costs on contraception disproportionally disadvantaging adolescents who are already marginalised. With limited access to contraception, when a young woman becomes pregnant, and the option of a safe abortion is unavailable due to the restrictive circumstances of rape, incest and health (ToP, 1977), she may end up being forced to marry to “save face” and not bring shame to the family. A 2022 landmark Constitutional ruling which was widely celebrated outlawed marriage before the age of 18 whereas in the past, girls could be married at 16 years while boys could marry at 18 years, yet child marriages continue to happen.
A UNICEF[4] report published in September 2023 shows staggering and worrying statistics for adolescent pregnancies. An estimated 1,706,946 Ante Natal Care(ANC) bookings were made in 1,560 health care facilities captured in the DHIS- 2 platform from 2019-2022 among women and girls aged 10 years and above. Of these, 21% were among adolescents aged 10-19 years. A total of 1532 maternal deaths were recorded and of these 25% were among adolescent and young women under 24 years. Of the estimated 50,957 pregnant women newly testing HIV positive, 0.1% were among adolescents aged 10-14 years, 15% among the 15-19 years. Adolescent pregnancy prevalence was 23.7% (337/1418) for adolescents aged between 10 -19 years. Among the 337 pregnant adolescences, 4.0% (20) had disabilities.
The UNICEF study found that 30% of the adolescent girls were sexually active and that sexual debut is 16 years. Sexual activity is unmatched with access to SRHR services as evidenced by the high number of unplanned pregnancies. The UNICEF report also highlights that one of the reasons for adolescent pregnancy was a restricted and sanctioned access to contraception. Socio-cultural beliefs and social expectation of how adolescents should handle themselves limited their access and uptake of contraception. Religion and cultural persuasions still expect adolescents to abstain from sexual activities until they are married when in reality, adolescents are sexually active as reported by UNICEF (2023) and SAT (2021).
Challenges faced by adolescents in accessing SRHR services include limited access to comprehensive SRHR services, high cost of contraceptives, stigma faced at health care facilities, child marriages in which adolescents cannot negotiate for use of contraceptives or safe sex. Attitudes and social norms have negatively impacted on the advocacy agenda for SRHR services and safe legal abortion for adolescents and limited access to SRH services is one of the leading causes of clandestine abortions.
Conclusion
Unplanned pregnancies amongst adolescents remains an issue of concern. If their future health and wellbeing is to be guaranteed, they need to be protected and supported to access comprehensive SRHR services at an affordable cost. Information dissemination amongst adolescents is key so they understand the provisions of various laws on SRHR including the Termination of pregnancy.
A call to action
Adolescents must be protected against unplanned pregnancies. Key action points are:
- They must be supported to access a package of comprehensive SRHR services which consists of information, education, counselling and referral to services.
- An SRHR law must be enacted with specific attention paid to the needs of adolescents.
- The archaic Termination of Pregnancy Act must be reviewed to cater for the changing reality and needs of adolescents.
- SRHR services must be made affordable for adolescents.
- Research must be conducted to understand the changing needs of adolescents’ SRHR needs and in turn develop age-appropriate interventions.
[1] UNFPA, 2012
[2] Sexual Reproductive Health and Rights Africa Trust , Access to Comprehensive SRHR by adolescents and young adults 2021.
[3] Amnesty International, 2018, Lost Without Knowledge: Barriers To Sexual And Reproductive Health Information In Zimbabwe. London, Amnesty International
[4] UNICEF, 2023
