By Kuda Pembere
In Zimbabwe, decisions on termination of pregnancy involving minors require careful consideration of consent, the child’s maturity and her best interests, an obstetrician and gynaecologist has said, highlighting the complexities healthcare workers face when providing reproductive health services to pregnant adolescents.
Speaking with HealthTimes, Dr Rumbidzai Makoni said healthcare workers should explain the risks and benefits of both continuing and terminating a pregnancy before supporting a patient’s decision, without imposing their personal beliefs.
“Consent is complex. It is generally individualized, with an assessment of the level of maturity the minor is showing.
“Once a minor becomes pregnant they become an emancipated minor therefore are in a position to consent for themselves, however this issue of termination would need guardian’s approval.
“In cases where the minor’s best interests seem to be undermined by the guardians the state can sometimes intervene and serve as the custodian to the minor. Confidentiality is a medical ethical issue that should be considered for every patient in every clinical circumstance,” she said.
Makoni said guardian involvement could become an issue when a pregnant minor sought termination of pregnancy, adding that the state could sometimes intervene where a guardian’s actions undermined the child’s best interests.
She said healthcare workers had a responsibility to provide information about available options and support patients after they had made a decision.
“As health workers we provide information on pros and cons of both termination of pregnancy and continuation of pregnancy, we talk about potential risks associated with each choice and once that choice has been made we support then, we perform the necessary procedures without imposing our own personal beliefs,” she said.
Makoni said patients were referred for psychological counselling and given follow-up schedules, home-care instructions and information about danger signs requiring medical attention.
Her comments come amid concerns about children who become pregnant following sexual abuse. In a recent case in Marondera Rural, a 42-year-old man was arrested after allegedly raping and impregnating his Grade Four stepdaughter, according to media reports.
The case highlights the medical and psychological challenges facing children who become pregnant through sexual violence, as well as the need for timely access to appropriate healthcare, protection and support.
Makoni said teenage pregnancy was associated with several physical and mental health challenges, including complications during pregnancy and childbirth.
“These young girls are victims who often get re-victimized — first by those close to them, and then by society at large. This stigma and isolation can easily lead to depression,” she said.
She said some adolescents delayed seeking antenatal care because they were unsure about the changes taking place in their bodies.
“They are often unsure of what is happening to their bodies, so they book late for antenatal care. Yet early booking is critical, as it allows us to assess and manage risk factors early,” she said.
Makoni said adolescent pregnancies carried increased risks of anaemia, hypertensive disorders and preterm birth, while poor nutrition could worsen outcomes.
She also warned that childbirth could be complicated by prolonged labour and injuries with long-term consequences, including incontinence, pelvic organ prolapse and sexual dysfunction.
“Caesarean section at such a young age also carries significant downstream complications for their future pregnancies,” she said.
A Caesarean section leaves a scar on the uterus that can affect subsequent pregnancies. Although many women who have had the procedure go on to have healthy pregnancies, a previous Caesarean can increase the risk of complications such as placenta previa, where the placenta covers the cervix, and placenta accreta spectrum, in which the placenta attaches too deeply to the uterine wall and can cause severe bleeding after delivery.
A previous Caesarean also increases the risk of uterine rupture during a subsequent pregnancy or labour, although the likelihood depends on factors including the type of uterine incision. Repeated Caesarean sections can lead to internal scar tissue, known as adhesions, which may make later operations more difficult and increase the risk of injury to nearby organs.
The implications are particularly important for children who may face several years of reproductive life after an early pregnancy. However, the risks vary between individuals and depend on their medical history, the circumstances of the first delivery and the care available during subsequent pregnancies.
Makoni said healthcare workers collaborated with psychologists and social workers to address the mental health and safety needs of pregnant minors. She said the collaboration was important to protect children from further abuse and ensure their best interests were considered.
She also emphasised the importance of confidentiality in medical care.
“Confidentiality is a medical ethical issue that should be considered for every patient in every clinical circumstance,” she said.
