By Dr Munyaradzi Murwira
Adolescents are a diverse group; their sexual and reproductive health needs and ability to meet those needs vary based on their life circumstances, including marital status and urban or rural residence. Adolescents often face a multitude of challenges in obtaining sexual and reproductive health services, including social stigma, judgmental attitudes of community, health care providers, financial constraints and lack of information. Key sexual reproductive health issues affecting youths include among others, STIs/HIV & AIDS, teenage pregnancies, unintended pregnancies, drug and substance abuse, and sexual gender based violence (SGBV).
The Zimbabwe teenage pregnancy study 2016-17 revealed that 9% of the adolescents aged 10-19 years had ever been pregnant, with 17% of the adolescents aged 15-19 years had experienced pregnancy (17.6% based on Multiple Indicator Cluster Survey – 2019). Adolescents with no comprehensive knowledge on pregnancy were at higher risk of pregnancy. Marginalised and vulnerable adolescents were more likely to get pregnant compared to adolescents from stable and richer families. Adolescents aged 15-19 years in rural areas were more likely to be at risk of pregnancy compared to their urban counterparts. Zimbabwe has formulated policies and laws related to adolescent sexual and reproductive health. The Age of Consent in Zimbabwe, which is 16 years, protects the girl child from sexual abuse. However, most cases of rape and abuse go unreported.
Consequences of Adolescent Pregnancy
The main consequences of adolescent pregnancy experienced by adolescents aged 15-19 years who got pregnant was dropping out of school, being chased away from home, abandonment by the man responsible for the pregnancy, abandoned by friends and family. Medical effects of teenage pregnancy include high risk of complications of pregnancy and delivery, with associated death of mother and the baby. More than a tenth of the adolescents reported that their first pregnancy did not end in a live birth (stillbirth or miscarriage/abortion). According to the 2016 Guttmacher study, adolescent women in Zimbabwe had an estimated 45,000 unintended pregnancies in 2016, accounting for 17% of all unintended pregnancies in the country. The proportion of pregnancies that were unintended was twice as high among unmarried adolescents (63%) as among married adolescents (32%). The proportion was also higher among adolescents living in urban areas (53%) than among those in rural areas (35%).
Access to Post Abortion Care
Barriers that prevent adolescents from accessing their sexual and reproductive health care needs put them at risk for unintended pregnancy and increase the chances that they will seek an unsafe abortion. While adolescents account for almost one-quarter of the female population in Zimbabwe, little is known about their experiences with abortion. According to the Guttmacher study, an estimated 4,100 induced abortions occurred among adolescent women in Zimbabwe in 2016. Although women of all age-groups had similar levels of unintended pregnancy, adolescent women had the lowest proportion of unintended pregnancies that ended in abortion (9% compared with 16–38% among other age-groups). These findings suggest that adolescent women in Zimbabwe carry a higher proportion of unintended pregnancies to term than older age groups. A higher proportion of unintended pregnancies ended in abortion among unmarried adolescents (13%) compared with married adolescents (6%), and among adolescents living in urban areas (25%) rather than rural areas (1%). Post abortion care can be lifesaving treatment for women with abortion complications. However, there are disparities in access to sexual and reproductive health care across age groups, with adolescents being 21% more likely than patients aged 20–49 to experience delays in getting post abortion care. Young people with unintended pregnancies face widespread stigma & discrimination (family, community & providers), have limited access to services (cost of services, provider attitudes), in addition they have high risk of accessing clandestine cheaper options for abortion, with resultant high risk of complications and death.
Conclusions & Recommendations
Adolescent pregnancy is a national health and social problem, requiring effective evidence based interventions targeting the identified vulnerable groups of adolescents. High levels of pregnancy among adolescents’ calls for tailored policies and programs to address the diverse needs of adolescents to prevent unintended pregnancy and resultant abortions. The recommendations include among others:-
Addressing socio-cultural and religious norms and community values that undermine rights of women and girls and perpetuate adolescent pregnancy in communities.
Enforcing laws and legislation that are in place in order to protect the girl child against early marriages and teenage pregnancy.
Strengthening female adolescent empowerment through life skills initiatives, female sensitive programmmes, and improving educational, socio-economic and recreational opportunities for young people.
Ensuring the provision of comprehensive sexual reproductive health education for all young people; increasing accessibility to services, targeting the differing needs of adolescents; and capacitation of health care providers to offer respectful and non-discriminatory sexual reproductive health services to young people.
Providing adolescents with information on the legal criteria for abortion and the provision of safe abortion services to the full extent of the law.
Mapping of adolescent pregnancy hotspots at sub-national level accompanied by focused interventions to address underlying factors.
Dr M Murwira is a Public Health Expert with special interest in Sexual Reproductive Health, and Population & Development.