An estimated 21 million girls aged 15 to 19 years and 2 million girls aged under 15 years become pregnant in developing regions every year (Darroch, Woog, Bankole, & Ashfold, 2016: United Nations Population Fund [UNFPA], 2015). Roughly 16 million girls aged 15 to 19 years and 2.5 million girls under age 16 years deliver in developing regions (UNFPA, 2015: United Nations Department of Economic and Social Affairs, Population Division [UN DESA], 2017).The global adolescent birth rate has dropped from 65 births per 1000 women in 1990 to 47 births per 1000 women in 2015 (United Nations Department of Economic and Social Affairs [UN DESA] 2017). Regardless of this overall improvement, because the global population of adolescents continues to grow, forecasts indicate that the number of adolescent pregnancies will increase globally by 2030, with the greatest proportional increases in West and Central Africa and Eastern and Southern Africa (Every Woman Every Child, 2015).Furthermore, regional differences reveal uneven progress: adolescent birth rates range from a high of 115 births per 1000 women in West Africa to 64 births per 1000 women in Latin America and the Caribbean to 45 births per 1000 women in South-Eastern Asia, to a low of 7 births per 1000 women in Eastern Asia (UN DESA, Statistics Division 2017). There are also up to three times more adolescent pregnancies in rural and native populations than in urban populations (Every Woman Every Child, 2015).
Adolescent pregnancies are a global problem that occurs in all countries despite their economic status. It is highly likely for adolescent pregnancies to occur in sidelined communities globally, commonly motivated by poverty and lack of education and employment opportunities (UNFPA, 2015). For some adolescents, pregnancy and childbirth are planned and wanted. In some instances, girls may undergo social pressure to marry and once married, to have children. Every year, about 15 million girls are married before the age of 18 years, and 90% of births to girls aged 15 to 19 years occur within marriage (UNFPA, 2015; United Nations International Children’s Emergency Fund [UNICEF], 2013).For many adolescents, pregnancy and childbirth are unplanned and unwanted while in developing regions adolescents have an unmet need for modern contraception. As a result, half of pregnancies among girls aged 15 to 19 years in developing regions are estimated to not be deliberate (Darroch, Woog, Bankole, & Ashfold, 2016).The core cause of adolescent girls’ deaths in 2016 were maternal conditions, self-harm and road injury respectively (World Health Organiization [WHO], 2016).
The adolescent fertility rate in Botswana is estimated at 51 births per 1000 women aged 15 – 19 years and the trend continues to rise. For the year 2016 there were 271 out of 315 261 in primary school, 1 194 out of 116 068 in junior secondary and 477 out of 57 203 in senior secondary. Majority of these drop outs are due to unplanned pregnancy which results from unprotected sex, therefore people are not only concerned of pregnancy, but also of high chances of transmission of STI’s and HIV/AIDS.
The government has put in place several interventions to reduce the cases. Botswana has embraced sustainable development as its development approach, and is fully committed to the 2030 Agenda for Sustainable Development, its principles, goals, targets and indicators. There are several targets that relate directly to SRH in the sustainable development goals, specifically goal 3 and 5 which intends to reduce adolescents pregnancy. Goal 3aims to insure healthy lives and promote wellbeing for all at all ages. One of its targets is to ensure universal access to sexual reproductive health care services, including for family planning, information and communication, and the integration of reproductive health into national strategies and programs.
Goal 5 aims to achieve gender equality and empower all women and girls. Some of its targets includes eliminating all harmful practices such as child early and forced marriages which lead to teenage pregnancy. In addition to that it also targets to ensure universal access to sexual and reproductive rights as agreed in accordance with program of action of the international conference on population and development. We now see adolescents being included in the sexual reproductive health programs which encourages them to know where, when and how to access those services.
According to UNICEF teenage pregnancy is defined as a teenage girl, usually within the ages of 13-19, becoming pregnant. Teenage fathers are young male who have children and are aged between 13 and 19.
Although it is not inevitable, some life circumstances place girls at higher risk of becoming teen mothers such as some social issues like poverty. Insufficient financial support can make teenage girls to be trap by their age mates’ males or older people in order to get some money for living. This may lead to unprotected sex since they are not free enough to stand for their rights or negotiate for safe sex, eventually falling pregnant.
The direct influence on people by peers, to change their attitudes, values or behaviors to conform to those of the influencing group or individual. Often, peers have more influence over teenagers than the parent, even if the relationship with parent-child is good. In most cases, these teens let their friends influence their decision to have sex even when they do not fully understand the consequences associated with it. Teenagers may have sex as a way to appear cool and sophisticated, but in some cases the end result is an unplanned teen pregnancy. This affect both male and female teenagers.
Teenagers lack knowledge on contraceptive usage. teenage girls lack information and proper usage of contraceptives e.g contraceptive pills and implant (Flanagan et al 2013).The inconsistent usage of contraception should not only be placed in young girls; young teenage boys should also play their part, since most of them have negative perceptions on condom usages, they believe it reduces sexual pleasure hence leading to teenage pregnancy.
One aspect that influence contraceptive usage is access to youth friendly services and its obtainability of birth control by the adolescents. For instance, the distribution of condoms and of all sorts are not placed where youth can access freely and privately and the judgmental approach and negative attitudes of health care workers also deters the youth from using the services.
Parents often neglect discussing sexual issues with their children, they play minimal role in transferring information to their teenage children (Macleod and Tracey, 2009). The several reasons are linked with cultural values and norms, religious reasons or fear that this may encourage early sexual engagement. However providing this information and educating children during their youth is an extremely important protective factor against teenage pregnancy. It is not only the teenage girl who needs to be educated about sex and how pregnancy occurs, but boys also.
Potential risk factors for a teenage girl to have early sexual behavior and / or become pregnant include: early dating and risky sexual behaviors (e.g., multiple partners, poor contraceptive use); early use of alcohol and/or other substance use; perceiving little or no opportunities for success and/ or negative outlook on the future; living in a community where early childbearing is common and viewed as the norm rather than as a cause for concern; growing up under impoverished conditions and poverty; having been a victim of sexual abuse or non-voluntary sexual experiences; or having a mother who was aged 19 or younger when she first gave birth.
Adolescent pregnancy is associated with higher rates of morbidity and mortality for both the mother and infant (Dangal, 2006). The younger the mother, the greater the chances of experiencing health complication. According to Nyarko (2016) teen mothers are at high risk of facing serious complications of pregnancy including first and third trimester’s bleeding, severe anaemia, prolonged and obstructed labour, cephalopelvic disproportion, and toxaemias of pregnancy, stillbirth and high prenatal mortality and morbidity. Their babies are likely to experience prematurity.
Teenage pregnancy hinders further education of female adolescents. It usually terminates a girl’s educational career, threatening her future economic prospects (Dangal 2006). Education will be put on hold as the teenage mothers will be forced to quit school first and come back if they have given birth (SmithBattle, 2017). Sometimes these teenage mothers never go back to school as they will have to stay home and take care of their young ones. They may decide to focus on the baby or getting married rather than pursuing their education.
In Botswana a teen mother can return to her former school after the cession of pregnancy as long as the doctor has certified her fitness. However, there is no guarantee for the return to school by such a girl, as it is still dependent on the availability of space in the relevant class. Some other reason some teenagers do not return to school after dropping out is because pregnancy is a culturally disapproved condition for a teenager and a stigma to the girl and the family, hence this affecting their economic status in the future.
Teen fathers may experience significant financial hardship, for providing financial support to their babies since they are young and not working. Occurrence of role transition may cause stress to the lives of teen fathers.
Teenagers are more prone not only to pregnancy and child bearing but also to diseases and conditions especially sexual transmitted infections as a result of unprotected sex.
Teenage mothers have a higher incidence of low birth babies. These babies are usually associated with birth injuries, serious childhood illness and mental and physical disabilities. Birth weight is strongly associated with infant mortality.
Berglund et al (2013) says being a teenager itself it is very hard, but adding in pregnancy and all that planning and preparing that comes with it, and it becomes even more challenging. Sometimes, “challenge” can be an understatement. Teenage pregnancy does not only affect the pregnant teenage but it also affect the child to be born, entire family, and it can also affect the teenage father. Collins, (2015) says both the teenage girls and boys face difficult challenges even though the girl may be affected to a greater extent than the boy. The challenges that are linked with teenage pregnancy can be emotional, social, physical, financial, and educational problems.
Emotional problems deals with intense mental feelings. Being pregnant at a young age leads to one experiencing a wide range of emotions, from being shocked, depressed and disappointed to constantly worrying about the future (Holgate et al, 2010). A teenage pregnant girl may have low self-esteem as she will prefer to keep to herself rather than opening up to someone. She well have fear on how she is going to present the matter to the family and how they will react. Another emotion that pregnant women experiences is the mood swings which can cause tension in any relationship, and it’s made worse when a teenager feel that they cannot control it (Holgate et al, 2010).
As for young males who become fathers while still in their teens they tend to be in moral dilemma of either avoiding paternal responsibilities or attempting to face such responsibilities at the same time as they cope with the developmental tasks of adolescence and school completion (Sullivan 2012).
A review of research in the 1980s showed that teenage fathers and mothers at that time often had unrealistic childrearing attitudes and a misunderstanding of children’s developmental milestones, such as when they should begin walking, talking, or toilet training. Young parents also tended to be emotionally and intellectually unprepared for parenthood and showed impatience and intolerance (Robinson, 2014).
Study conducted in 2013 shows that many teens experience significant financial hardship therefore, a family will have to take part and these may lead to the family changing its budget (Cundy, 2013). A family of low socio economic status experiences additional strain on family resources for example food, because a pregnant woman does not eat everything therefore it is up to the family members to see what kind of food they give to the teenage mother. Also the young mother’s family is drained financially when the baby is born due to everyday expenses such as the clothing, diapers and milk if the mother does not breastfeed. Sometimes the baby’s needs are not meet due to shortage of money. These financial problem may also affect both teenage mother and father negatively because their financial issues are not fully attempted to as the money will be saved for the coming baby.
It deals with mutual relationships with significant others such as parents, partner, family, peers, as well as with socialization, recreation and role models (Holgate et al, 2010). A teenage mother may loss relationships due to isolation and also as the result of the attitude from their peers. Negative feedback from friends, family and society may leave a teenager who is pregnant feeling like a failure in life and lead to anxiety and stress. They might also experience stigma from the environment they are living in. Due to all these experiences, the teenage mother may end up having low self-esteem and majority of them tend to hide behind the walls (Holgate et al, 2010). All these social problems can lead to teenage mother giving up in life and resorting to abort the child or even ending their lives since they lack support in their difficult times.
Physical problems are the difficulties the teenage mother experiences through becoming and being a teenage mother related to her body and physical health status (Letourneau et al, 2014). These difficulties are brought about with the young mother’s body not fully matured to carry a human being. Therefore, the teenage mother might end up having difficulties in delivery through spontaneous vaginal delivery leading to the doctors choosing to do a cesarean sections which put their lives at risk. The teenage mother may also give birth to a premature baby, and there is a greater risk for her to experience cephalopelvic disproportion (when the baby’s head is wider than the pelvic opening) during birth (Letourneau et al, 2014). Also during the period of pregnancy the young mother may encounter some health problems like anemia (low iron levels), high blood pressure/pregnancy induced hypertension, (PIH).
Option to abortion including unsafe abortion, leads to high risk of maternal morbidity and mortality. The abortion rate was much higher for older teens, even though pregnant 15 to 17-year olds were more likely than pregnant 18 to 19-year olds to have an abortion (Otoide et al,2001)
Many prevention programs are designed to reduce the number of adolescent pregnancies and sexually transmitted diseases (STDs). These programs aim to improve the use of contraception and to modify the high-risk behaviors associated with teenage pregnancy and STDs.
Abstinence-only programs teach that abstinence is the only certain way to avoid unwanted pregnancy, STDs, and associated health problems. It does not teach about, endorse, or promote contraception use but rather it encourages adolescents to refrain from sexual intercourse. Parents, teachers and health workers should facilitate these programme to help students take informed decision on abstinence.
Comprehensive sex-education curricula present abstinence as the most effective method of preventing pregnancy and STDs but also discuss contraception as the appropriate strategy for persons who are sexually active (Kirby, 2001). According to government of Botswana/UNFPA programme 2017-2021, it aims to have improved guidelines and standards for the design and implementation of community and school-based comprehensive sexuality education programmes that promote human rights and gender equality. The programme focus on advocacy and technical support for the institutionalization of comprehensive sexuality education in primary school curricula hence this will reduce numbers of pregnancies among teens. Development of comprehensive strategies for prevention of teen pregnancy should be carried out by schools, parents, religious institutions and the community.
The intrauterine devices (IUDs) and the subdermal implant, collectively known as long-acting reversible contraceptives (LARC), along with the Depo-Provera shot, represent highly efficacious methods of birth control for all reproductive-age women, including adolescents (Itriyeva, 2018). They are also safe, private, and convenient, and can be used for their no contraceptive benefits. Lastly the IUD offers years of protection, typically between 3 and 10 years depending on the type of IUD, therefore this protection can help to prevent pregnancies among adolescents.
Governments need to have clear, consistent legislation which establishes the minimum age of marriage and ensure that adequate safeguards are in place so that parental consent or other exceptions are not used to force girls into marriage (Kalabamu, 2006). The Marriage Act (CAP 29:01) places the marriageable age at 21 years of age as they deemed to become an adult so these laws and policies have to be enforced and strengthened to reduce teenage pregnancies and teenage marriages.
Youth Friendly Services are services designed to serve and address the sexual reproductive health needs of the young people in Botswana, they include counselling, contraceptives services etc. There are some non-government organizations like Botswana Family Welfare Association (BOFWA), Young Women Christian Association (YWCA) which provide services to the adolescent. These services have to be in the right place, and the in the right style that suit the youth and adolescent and be acceptable to the youth themselves which can help reduce pregnancies (WHO, 2002).
Life skills are abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life. They include communication skills, negotiating safer sex, decision making and assertiveness. The empowerment of adolescents is a major concern of parents, teachers and government. (Srikala, & Kishore, 2010). When adolescents are empowered enough they will negotiate safer sex and good communication skills which will help in preventing pregnancies as they are able to decide what to do, when to do and how to do.
Adolescent pregnancy is a global problem and has become a major public health concern. In order to reduce the rate of teenage pregnancy adolescents, their parents and community should be made more aware of the negative health, social and economic consequences of it. Such awareness could be created through social mobilization, information dissemination, sex education and communication campaigns. Each and every aspects of teenage pregnancy should ideally be dealt with carefully and sensibly to reduce the occurrence, complications and societal burden
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