African teenage pregnancies soar during COVID lockdowns - but prevention is possible - Health Policy Watch

African teenage pregnancies soar during COVID lockdowns – but prevention is possible – Health Policy Watch

A teenage mother in Rwanda’s Karongi district.

17-year-old South African Amanda Nkosi* is already a mother and living with HIV – thanks to what she describes as “doing things teenagers do” without access to accurate health information or contraception.

She found out about her HIV status recently when a youth-friendly clinic opened near her home in the coastal city of Durban and offered her a test when she went to pick up contraception. She loved the clinic because it offered her services without feeling judged and now helps educate other teens about HIV and their bodies.

South Africa has one of the highest rates of HIV in the world, and young women bear the brunt of this statistic. Meanwhile, the country’s battle against teenage pregnancies has been severely undermined by COVID-19 shutdowns and school closures – with teenage pregnancy spikes across the continent during pandemic shutdowns in 2020 and 2021.

South Africa’s most populous province, Gauteng, reported a 60% jump in teenage pregnancies between April 2020 and March 2021. More than 23,226 teenage girls aged 10 to 18 gave birth during this period compared to 14,577 girls in the same period a year earlier.

Nkosi shared her story during a webinar hosted by Clinton Health Access Initiative (CHAI) and Health Systems Trust to discuss how to deal with teenage pregnancy in South Africa.

Describing most teenage pregnancies as ‘abuse’, CHAI country director Dr Yogan Pillay said young people in Southern Africa were much more likely to contract HIV and other sexually transmitted infections as well as mental health issues if they started having sex at an early age. .

“Children are also more likely to have babies born prematurely, with lower birth weight and higher neonatal mortality,” added Pillay, former deputy director general of the country’s health department.

“Teen mothers experience higher rates of postpartum depression and are less likely to initiate breastfeeding. Teenage mothers are less likely to complete high school, more likely to live in poverty and have children who frequently experience health and developmental challenges,” he added.

Pillay said a systematic review of predictors of teenage pregnancies in sub-Saharan Africa found the most common causes to be sexual coercion, low or incorrect use of contraceptives, lack of communication and parental support, low socio-economic status and school dropout.

Addressing these issues would help reduce the number of teenage pregnancies and help teenage parents avoid further unwanted pregnancies.

Increase in pregnancies in confinement

Many African countries have seen an increase in teenage pregnancies during COVID-19 lockdowns and school closures, and relevant health policymakers are struggling to implement effective strategies to curb teenage pregnancies. teenage girls.

According to Uganda’s 2016 Demographic and Health Survey, a quarter of girls aged 15-19 had ever had a pregnancy. However, teen pregnancies increased by 28% during the first COVID-19 lockdown in 2020, according to Makerere University School of Public Health. In Busoga sub-region in eastern Uganda, 45% of deliveries were to girls under the age of 17, according to the Ministry of Health.

The Ugandan government’s approach to tackling teenage pregnancy has been to promote abstinence-based education in schools. Comprehensive sex education has been banned in schools and abortion is illegal.

However, given the enormous burden of teenage pregnancies, some Ugandan parents demand more effective sex education in schools and access to contraception for adolescents.

Ethiopia, Ghana, Kenya and Zambia have also reported increases in the number of teenage pregnancies due to lockdowns. For example, a recent Kenyan study found that girls under 17 in Siaya County who were under lockdown measures were twice as likely to get pregnant and three times more likely to drop out of school than those who were not under lockdown .

Tackling the problem

UNFPA runs a four-year program in 10 countries in Eastern and Southern Africa called 2gether 4SRHRwith the participation of UNAIDS UNICEF and the World Health Organization (WHO). Supported by the Swedish International Development Cooperation Agency (SIDA), it aims to improve sexual and reproductive health (SRH) services in the region.

“This includes scaling up client-centred, quality, integrated and sustainable SRH, HIV and sexual and gender-based violence services, and empowering young people to exercise their SRH rights,” according to UNFPA.

“In many countries in the region, adolescent girls and young mothers have higher rates of unplanned pregnancies, low uptake of antenatal and postnatal care, and those living with HIV have lower adherence to treatment regimens and lower viral load suppression,” according to the UN agency. .

“Every week, nearly 3,500 adolescent girls and young women in eastern and southern Africa become infected with HIV.”

Teenage mothers also tend to drop out of school and often never return.

Rebecca, a peer educator, leads a discussion on HIV prevention with young mothers.

More pilots

Unlike most other African countries, young South Africans can both end unwanted pregnancies before 20 weeks and have access to contraception – and none need parental consent.

However, many adolescents avoid clinics due to critical treatment from health workers. For this reason, youth-friendly clinics have long been hailed as one of the solutions to teen pregnancy.

However, Dr Thato Chidarikire, acting chief director of child, youth and school health at the South African Department of Health, said lack of resources was a problem.

“Not all primary health care facilities provide youth-friendly services and have functional, youth-dedicated consultation times. There is a high turnover of qualified staff and no dedicated resources to support youth health programs,” she conceded.

“Considerable evidence” of what works

Dr Venkatraman Chandra-Mouli from the WHO said there is considerable evidence of effective approaches to reducing teenage pregnancy.

“What we need are large-scale, sustained programs. And fortunately, we now have experiences from a growing number of countries of such programs,” he said.

“All of these programs had five components,” according to Chandra-Mouli of the Sexual and Reproductive Health and Research Unit.

“First, they put scaling on the national agenda. Second, they proposed a multi-component package of interventions, not just sexual and reproductive services or sex education. Third, they put money on the table from internal and external sources and managed scaling. Fourth, they built support for the program and anticipated and addressed resistance when it occurred. And finally, they worked strategically to ensure sustainability.

*not his real name.

Image credits: UNFPA Rwanda, UNFPA.

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