The sexual health of young people is a major global concern. Adolescence is the period between 10 and 19 years with peculiar physical, social, psychological and reproductive health characteristics while teenage pregnancy refers to females becoming pregnant at or before the age of 19.
Every year, 21 million teenagers in developing countries become pregnant, with 10 million of these pregnancies being unintended. Twelve million girls aged 15–19 and 777,000 girls under 15 years give birth annually. The global adolescent fertility rate has declined by 11.6 percent over the past 20 years to 42 per 1,000 but there are geographical disparities, with the sub-Saharan region leading at 101 per 1,000.
An increase in teenage pregnancies has been observed in Kenya. The World Bank data shows Kenya’s adolescent fertility rate at 74 per 1,000 in 2018 while in 2019 the Global Childhood put the national teen pregnancy rate at 82 per 1,000 births. It is therefore not shocking to hear of higher numbers of teenage pregnancies following the Covid-19 lock down.
Factors contribute to adolescent pregnancies include lack of information about sexual and reproductive health and rights; inadequate access to health services tailored to young people; family, community and social pressure to marry; sexual violence; child, early and forced marriage; limited educational and employment prospects; and peer pressure.
Cross-generational relationship where teenage girls have limited say, transactional sexual relationships, unwanted sexual advances, coercive sexual relations, unequal gender power relations and lack of autonomy, poverty, religious beliefs, lack of parental counselling and guidance are also to blame.
Other factors are parental neglect; deviation from the conservative traditional societal values; weak comprehensive sexuality education; challenges in access and use of contraceptives including misconceptions; males’ irresponsibility in sexuality; early sexual debut; inappropriate forms of recreation; use of alcohol and substance abuse; low self-esteem; upsurge in cell phone and social media usage; and restrictive laws and policies regarding provision of contraceptive based on age or marital status.
Teenage pregnancy has considerable effects on social, health, and economic outcomes.
These include complications during pregnancy and childbirth, systemic infections and unsafe abortions all contributing to deaths, diseases and long term health problems; low birth weight, preterm delivery and severe neonatal conditions for the newborns; repeat pregnancies; stigma, rejection or violence; discontinuation of schooling jeopardising education and employment opportunities hence vicious cycles of poverty; early marriages; and large family sizes.
Currently prevention programmes are designed to increase abstinence, improve the use of contraception, offer comprehensive sexuality education and youth development and to modify the high-risk behaviours associated with teenage pregnancy.
Teenage pregnancy trends could be reversed if a new architecture of policies that affect and integrate prevention is urgently introduced, as well as the mitigation of the effects of pregnancy through care and protection.
While measures to curb teenage pregnancies have largely focused on females, it takes two to create a pregnancy hence boys and men should not only be held responsible for their sexual behaviour but also targeted with interventions.
Involving boys and men makes programming for girls more effective by addressing both sides of the teen pregnancy equation. Measures to reduce teenage pregnancies should include: monitoring sexual activity and contraceptive use among teenagers to help inform understanding of the risk of pregnancy; community-based programmes, led by men to educate adolescent boys on responsible manhood; mainstreaming male juveniles in the criminal justice system in prevention efforts; campaigns to encourage teen boys to abstain from sex and to use contraception if they are sexually active; enforcing statutory rape laws against adult men involved with younger minor girls; and having child protection policies and programmes integrating specific components on early sexual debuts.
Parents should be clear on sexual values and attitudes; talk with their children early and often about sexuality; supervise and monitor their children’s activities; know their children’s friends and their families; discourage early, frequent and steady dating; take a strong stand against cross-generational relationships; help teens have options for the future that are much more attractive than early pregnancy and parenthood; emphasise the value of education; know what their children are watching, reading and listening to; and strive for an open-door relationship firm in discipline and rich in communication with their children.
Mugambi is a public health specialist