Adolescent Childbearing in Africa
Adolescent sexual and reproductive behavior in Africa
It is abundantly obvious to researches and laypeople alike that AIDS is a huge risk associated with adolescent sexual activity in sub-Saharan Africa. However, the negative sequelae of adolescent childbearing in the same region is of particular concern as well. Although the act of becoming pregnant is even easier to understand than is getting AIDS, as Kiragu and Zabin point out, “within any given society, the issue of adolescent fertility is rarely monolithic. In fact, the complexity of its consequences is often underscored by the contrast between two or more different aspects of the problem that exist within a single society; each may have serious consequences but often very different implications for intervention” (1998, p. 210+). They note that among the consequences are both physical and economic ones.
Contributing to both problems is the manner in which adolescent sexual activity in the region is changing. Aside from the fertility issue, Dijamba noted that most young women in Kinshasa, subject of a study by Dijamba, now engage in sporadic, nonsteady types of relationships, despite the fact that premarital chastity was still widely accepted as the norm, at least in Congo (Pillai & Barton, 1998). Dijamba noted that “exposure to mass media, formal education, delay in marriage, and other changes in social and economic environment may have reduced the role that traditional norms and values play on female socialization and union formation” (2003, p. 237+).
Dijamba affirmed the high rate of premarital sexual activity in developing counties is of concern because of the increasing incidence of HIV / AIDS and other STDs (sexually transmitted diseases).
UNICEF (2002) provides the information that 5.2 million people acquire HIV each year, with more than half being young people between ages 15 and 25. In addition, a UNAIDS (2002) report noted that the situation is “more alarming in Africa, a continent that is home to 70% of the adults and 80% of the children living with HIV in the world today” (quoted by Kiragu and Zabin, 1998, p. 210+).
Early childbearing in Africa
While AIDS is a problem for both genders, early marriage and “youthful childbearing” would logically take a higher toll on young females in Africa. Kiragu and Zabin noted that “primarily among young people in urban and periurban areas…increased independence, schooling, later age at marriage, and, often, economic necessity are combining to break down patterns of premarital abstinence where they once existed, or to change the context of sexual behavior where premarital patterns existed before” (1998, p. 210+). Not surprisingly, researchers have been particularly interested in the phenomenon when early childbearing interrupts education.
Kiragu and Zabin contend that while it commands less interest than AIDS, STDs and out-of-wedlock sexuality itself, “an immense reservoir of suffering is caused by childhood marriage and immediate postpubertal childbearing among girls given in marriage at ages as young as ten or 12” (1998, p. 210+). These authors also contend that African governments remain silent about the problem because of the cultural, political and religious implications.
Health risks for adolsecents with sexual activity and childbearing
Kiragu and Zabin quote a World Health Organization estimate that in Africa, 870 mothers die for every 100,000 live births, which is double the ratio that exists in Latin America and 80 times that in northern Europe (Kiragu and Zabin, 1998, p. 210+). That figure is very nearly one from Sweden in the mid-1700s, when the rate was 900 for every 100,000 live births. And, like people in Europe in the 1700s, Africans today tend to simply accept postpartum morbidity as “normal and unavoidable” (Kiragu and Zabin, 1998, p. 210+).
Postpartum death is not, however, the worst effect. In addition, another 16 women per 100,000 live births are injured, disabled, or rendered otherwise incapable of continuing their daily activity. Kiragu and Zabin note that, if the estimate is accurate, although 150,000 women die each year during the childbearing years, nearly 2.4 million incur some disability because of the pregnancies (1998, p. 210+). Moreover, these figures do not include the incidence of chronic problems that may only become obvious long after childbirth (Koblinsky et al., 1993).
Among the observable health risks for adolescents bearing children is high blood pressure, which is, in fact, “the primary pregnancy complication that afflicts adolescent mothers” (UN, 1989). This can result in a constellation of other problems, including pre-eclampsia (or toxemia), which, if uncontrolled, can lead to seizures, convulsions and cerebral hemorrhage (WHO, 1991). These conditions develop rapidly and are difficult to prevent; they are, however, often associated with premature delivery and therefore with increased rates of neonatal death as well (Kiragu and Zabin, 1998, p. 210+).
While half of the world’s pregnant women are thought to be anemic, the problem is considered to be even more severe in sub-Saharan Africa, occurring most frequently among adolescent women. In Nigeria, 60% of 496 teenage mothers were found to be anemic by one set of researchers, compared with 15% of 500 women aged 24-30 (Kiragu and Zabin, 1998, p. 210+). They note that “Because her developing body must compete for nourishment with her fetus, a teen’s pregnancy further depletes her iron and nutrient reserves,” (Kiragu and Zabin, 1998, p. 210+), which in turn can led to premature delivery and the rest of the complex of serious complications of pregnancy in African adolescent mothers.
Adolescents are also exposed to an increased risk of infection because of the generally more complicated labor and delivery found in this group, as noted above. In addition, these infections can ascend through the dilated cervix and, in the uterus, find excellent conditions for growth y in the remnant products of conception. “Women surviving infections may develop pelvic inflammatory disease (PID), ectopic pregnancy, infertility, and chronic pelvic pain” according to other researchers as well– Lettenmaier et al., 1988 — cited by Kiragu and Zabin, 1998, p. 210+). Traditional practices, too, can contribute to this problem, including such practices as the Yoruban practice of introducing herbs into the vagina to hasten delivery (Kiragu and Zabin, 1998).
Worse still, the effects of infection are often compounded when the adolescent mother is suffering from such endemic and often pre-existing diseases as malaria and tuberculosis, or, of course, anemia. Pregnant women might also acquire infections due to the suppression of their immune systems during pregnancy (Kiragu and Zabin, 1998, p. 210+).
Social and economic risks of early childbearing
There are conflicting thoughts about the social and economic bases and risks of childbearing. Some researchers, Dijamba among them, believe that “Although women may be freed from some strictures placed upon them when they are under closer, kinship-based control, their economic condition may force them into liaisons — some of which are seen as extensions of the tradition of polygyny — in order to survive poverty or to continue their schooling or chosen careers” (2003, p. 237+).
Kiragu and Zabin argue for the “rational adaptation hypothesis” that contends that the current sexual behavior/childbearing of sub-Saharan African young women is economically motivated. They note, with Dijamba, that because of gender inequality in the distribution of available resources, women are in a disadvantaged position in most societies (Dijamba, 1997; Kiragu and Zabin, 1998). It has already been noted that schooling is often interrupted, thereby ensuring continuing economic hardship for mother and child. The implication of the work of Dijamba and Kiragu and Zabin is that the young women attempt to solve their poverty problems by forming alliances, through sexuality and childbirth, with males.
What can be done?
A recent study was conducted in four African nations to determine the effects of an adolescent sexual health campaign; each relied to a differing extend on mass media, sponsored events, peer education and youth-friendly contraceptive services.
Of the four interventions, the one in Cameroon, relying on a combination of mass media and peer education and lasting longer than the other three, had:
The greatest impact on different dimensions of sexual health beliefs and behavior. It produced a net increase in perceived benefits of protective behavior and in self-efficacy among both males and females, and a reduction in perceived barriers to protective behavior among females. Consistent with these changes, it was also associated with a reduction in risky sexual behavior among young men and an increase in contraceptive use among young men and women (Agha, 2002, p. 67+).
Agha also noted that there was more positive change among young women than among young men, a fact that “may reflect a better ability of these adolescent sexual health interventions to address the concerns of women than of men, or a greater receptivity to such interventions among young women than among young men” (2002, p. 67+). Because of the success of this program, however, Agha suggests that means of reaching young men to the same extent are worthy of additional study, and multi-media, educational programs of long duration are likely to result in lower incidence of HIV and STDs, as well as decreasing the rate of adolescent childbearing.
Agha, Sohail. “A Quasi-Experimental Study to Assess the Impact of Four Adolescent Sexual Health Interventions in Sub-Saharan Africa.” International Family Planning Perspectives, vol. 28, no. 2 (2002), vol. 28, no. 2, p. 67+. Retrieved October 12, 2005 from www.questia.com.
Dijamba, Yanyi K. “Social Capital and Premarital Sexual Activity in Africa: The Case of Kinshasa, Democratic Republic of Congo.” Journal Title: Archives of Sexual Behavior. 32, no. 4, (2003), 327+. Retrieved October 12, 2005 from www.questia.com.
Kiragu, Karungari and Laura Schwab Zabin. “The Health Consequences of Adolescent Sexual and Fertility Behavior in Sub-Saharan Africa.” Studies in Family Planning, vol. 29, no. 2 (1998), 210+. Retrieved October 12, 2005 from www.questia.com.
Koblinsky, Marjorie A., Oona M.R. Campbell, S.D. Harlow. “Mother and more: A broader perspective on women’s health.” In The Health of Women: A Global Perspective. Ed. Marlene A. Koblinsky, Judith Timyan, and Jill Gay. Boulder, CO. Westview Press. (1993) Pp.33-62.
Lettenmaier, Cheryl, Laurie Liskin, Cathleen A. Church, and John A. Harris. “Mothers’ Lives Matter: Maternal Health in the Community.” Population Reports Series L, No 7. (1988) Baltimore: Johns Hopkins University, Population Information Program.
Pillai, T., & Barton, T.R. “Modernization and teenage sexual activity in Zambia: A multinomial logit model.” Youth and Society, 29, (1998). 293-310.
United Nations. 1989. Adolescent Reproductive Behavior: Evidence from Developing Countries, Vol. 11. New York: United Nations (UN Population Studies No. 109/Add.1).
World Health Organization. (WHO). 1991. Maternal Mortality: A Global Factbook. Geneva: WHO.