SOUTH AFRICA – Adolescent girls’ experiences of pregnancy in rural Limpopo Province

by Patrone Rebecca Risenga, Sheillah Hlamalani Mboweni

Adolescents 2023;3(1):60-71. (Open access) Special Issue: Gender Equity and Girls’ Health

Every year, 7.3 million girls become pregnant before they turn 18. Teenage pregnancy increases when girls are denied the right to make decisions about their sexual health and well-being, which is a gender equality issue. Among the challenges of gender equality are those expectations that communities have about girls and early motherhood, sexual violence, and rape. Another challenge is the early marriages of children to older men coupled with the unique risks faced by these girls during pregnancy, for example, the interruption of their education, health risks, such as HIV, premature birth, and increased maternal mortality, denying the girls the right to live a healthy life. This study sought to explore the experiences of adolescent girls regarding teenage pregnancy in the rural villages of the Mopani District, Limpopo. A descriptive, explorative, and qualitative design was followed to collect data from 20 pregnant teenagers in a 13-19 year-old age group. A non-probability, purposive sampling method was used to select the participants from the three villages of the Mopani District. The data were collected using an in-depth individual interview. Tesch’s eight steps of data analysis were also applied. The study findings reveal several factors that explain the high rates of teenage pregnancy in rural Limpopo. Among these are the socioeconomic and cultural factors that predispose teens to pregnancy. The consequences of teenage pregnancy were expressed in terms of regret and ill health.

Introduction and Background
Every year, 21 million girls aged 15–19 years in low- and middle-income countries (LMICs) become pregnant, and of these, approximately 12 million give birth. A total of 777,000 births occur among adolescent girls younger than 15 years. Teenage pregnancy increases when girls are denied the right to make decisions about their sexual health and well-being, which is a gender equality issue. Teenage pregnancy is a public health concern in high-income countries (HICs) and LMICs and has social consequences for unmarried pregnant teenagers, which include stigma, rejection, or violence by partners, parents, and peers. In addition, girls who become pregnant before the age of 18 are more likely to experience violence within a marriage or partnership. Furthermore, complications during pregnancy and childbirth are the leading cause of death of 15-19-year-old girls globally. Of the approximately 5.6 million abortions that are carried out each year among adolescent girls aged 15–19 years, 3.9 million are unsafe, contributing to maternal mortality, morbidity, and lasting health problems. The World Health Organization also states that adolescent mothers (aged 10–19) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24, and the babies of adolescent mothers face higher risks of low birth weight, preterm delivery, and severe neonatal conditions.

South Africa has a large proportion of young people, and teenage pregnancy has emerged as one of the major public health problems. A shocking 2020 report from Statistics South Africa shows that there were 33,899 adolescent mothers, representing 17.1% of the population, and 660 babies birthed by girls aged 10 years or under. The teenage pregnancy statistics of girls between 10 and 17 years reveal that Kwa-Zulu-Natal is the leading province for teenage pregnancy, followed by Limpopo in South Africa. Barron et al. conducted a retrospective study using data from three districts on health information from 2017–2021 and discovered that teenage pregnancy among 10–14-year-old girls increased by 48%, and the birth rate per 100 girls in this age category increased by 1.1 to 1.5. The study also mentions that teenage pregnancy among adolescent girls aged 15–19 increased by 17.9%. These rates are higher in rural areas such as Limpopo, Mpumalanga, and the Eastern Cape, as well as in urban areas such as Gauteng and the Western Cape.

According to Lindroth, young women in low-income countries were commonly forced to go through with unplanned pregnancies and suffer from sexually transmitted infections, which might result in them falling victim to gender-based violence. The study also highlights that the majority of the world’s adolescents lack enough knowledge of sexual reproductive health rights, which makes them more exposed to unplanned pregnancies, sexually transmitted infections, and sexual violence. Another study conducted by Moult & Müller further reveals that sexual and reproductive health (SRH) is far from settled by either the healthcare professionals who provide these services or by young people who must seek them. Without sexual and reproductive health knowledge, teenagers are more vulnerable to teenage pregnancy and its complications.

Chapter 2 (Section 9(3)) of the Constitution of the Republic of South Africa of 1996 describes that the state may not unfairly discriminate directly or indirectly against anyone on one or more grounds, including race, gender, sex, pregnancy, marital status, ethnic or social origin, sexual orientation, age disability, religion, conscience, belief, culture, or birth, which includes pregnant learners. However, this does not mean that the state should keep quiet while the future of a child girl is affected. Measures must be put in place to deal with pregnancy as an issue affecting teenage girls. A study conducted by Gibbons et al. indicates that, regardless of advances in access to education at primary and secondary levels, women still face significant challenges, such as their ability to engage in unpaid work and to be employed in the informal sector. This also makes it more likely that South African women will live in poverty and become victims of interpersonal violence. Therefore, this study sought to investigate adolescent girls’ experiences regarding teenage pregnancy in the rural villages of Limpopo. The key research question is, what are adolescent girls’ experiences regarding teenage pregnancy in the Mopani District?

Problem statement 
Between April 2017 and March 2018, a total of 16,238 children were born to adolescents in the province of Limpopo’s state-owned hospitals. Teenage pregnancy rates escalate daily, and Limpopo has the second-highest rate in South Africa. Limpopo reported 5954 teenage pregnancies in 2020, birthed by teenagers between 10 and 17 years old. There is an outcry against teenage pregnancy in the Mopani District, where even primary school teens are falling pregnant. In July 2017, one primary school in Mopani had two teenagers in the age group 14 to 16 years who were pregnant, and in one high school in the same vicinity, 37 teenagers were pregnant. In July 2018, the researcher visited a primary school where four Grade 5 learners, who were younger than 14, were mothers. This reflects the crisis faced by the Mopani District regarding teenage pregnancy. School teachers complain about absenteeism, specifically among those girls who are reported to be pregnant, and absenteeism leads to poor academic achievement. If the rate of teenage pregnancy keeps on rising, what will the implications be for the sexual and reproductive health rights of women in the Mopani District in the future? Will teenage pregnancy cripple the educational and economic aspects of future families by harbouring poverty? This has a bearing on the educational and economic level of women in South Africa. Something must be done to address the challenges related to teenage pregnancy among girls in the Mopani District, hence the need for this study.

SEE ALSO: Over 600 Limpopo schoolgirls fall pregnant annually, Citizen 18 September 2018 ; PHOTO: Sowetan Live 2013-03-12