Teenage Pregnancy in SA
Saadhna Panday and Hleki Mabunda
Department of Basic Education
for the
Portfolio Committee on Basic Education
1 September 2009
Outline of presentation
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Background
Methods
Trends in Fertility
EMIS Data
Conceptual Framework
Determinants
Interventions
Recommendations
Conclusions
Response of the Department
Background
• High teen fertility subject of concern in research
& policy circles
• Available data suggests progress has been
made since democracy
• Longer period spent in education coincides with
sexual development
• DOE adopted a rights-based approach
• Introduced guidelines to prevent & manage
teen fertility
• Policy & practice must be informed by the
context of teenage pregnancy
Methods
• Purpose: critical analysis & review of
data - focus on learner pregnancy
– Desktop review of literature
• 2003 RHRU Survey, 2006 Kaiser/SABC Survey,
2002, 2005 SABSMM Surveys
– Trends in fertility
• 1996, 2001 Census data, 1998 SADHS, 2007
Community Survey, DSS
– Secondary analysis
• EMIS data 2004-2008
• HSRC 2003 Status of Youth Survey
Fertility
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Definition: fertility vs. pregnancy
Lack of vital statistics in SA
Overall fertility declining for 50 years
SA lowest fertility rate in mainland SSA
Teenage fertility has declined in SA
But at a slower pace, due to spikes in fertility
related to national epochs
• Fertility declined by 10% between 1996
(78/1000) and 2001 (65/1000) & by further 10%
by 2007 (54/1000)
Declining teen fertility
Teenage Fertility 1980-2007
90
80
70
Fertility
60
50
Series1
40
30
20
10
0
1980
1985
1990
1996
2001
2007
Years
Source: Moultrie & Timaeus, 2003; Statistics South Africa, 2008; Udjo, 2003
Why perception of an upsurge?
• Increased visibility of teenage pregnancy - seen
at schools, in communities, collecting CSG
• Proportionally, teen contribution to overall
fertility has increased
• Confluence between issues of:
– morality
– strategies to reduce teenage pregnancy,
– enforcement of responsibilities of young
mothers
– assistance given by society to children of
teen mothers
Rates higher in some groups
Contribution to teen pregnancy by age
15 yrs 16 yrs
1%
6%
17 yrs
22%
19 yrs
48%
18 yrs
23%
Source: Harrison, 2008b
Rates higher in some groups
continued
Source: Moultrie & McGrath, 2007
Rates higher in some groups
continued
Source: Pettifor et al., 2004
EMIS Data
• Caution – missing data in some provinces
• Rise in learner pregnancy – most likely result of
improved reporting rather than a real increase
• Rates higher in schools:
– Located in poor neighbourhoods (no fee
schools, farm schools)
– Involving age mixing (combined schools)
– Poorly resourced (lower in specialised
schools)
The CSG Myth
• No empirical evidence of link between teen
fertility & CSG
• Teenage fertility has been declining through out
the period that CSG has been available
• Termination of pregnancy by teens has been
increasing throughout the period
• Low uptake of CSG among teenagers
• Evidence of higher school enrollment and better
nutrition to children who receive CSG
Rates higher in some groups
continued
• Increase in education → decrease in fertility
• Pregnancy results from rather than causes
dropout
• Dropout & pregnancy share common causes:
– poor school performance
– poverty
• Dropout is a significant risk factor for early
pregnancy & HIV
• Despite SA’s liberal policy, only about 1/3 of
teen mothers return to school
• For every year that teen mothers are out of
school, their chances of returning decreases
Termination of pregnancy
• Legalised since 1996
• Conflicting data
– Survey data – low levels of use (3%)
– DOH data – suggests ↑ use (30%)
• Girls apply ‘relative morality’ to protect
education & avoid social & financial hardships
• High use of illegal services
• Barriers to using legal services
– Poor knowledge about legality, costs &
period for safe termination
– Stigma from community & health care setting
– Families & partners often decision-makers
Reasons for decline in fertility
• Decline in fertility related to:
– ↑ in access to family planning services
(dramatic ↑ in contraceptive use)
– ↑ in access to education
– Shift in attitudes to pregnancy in late 1990s
• ⅔ of pregnancy unwanted because of
educational aspirations
• But rates remain unacceptably high
– High levels of knowledge of contraception
– But incorrect & inconsistent use persists
Increase in condom use
Condom use at last sex among 15-24 year olds, 2002-2008
100
90
80
70
60
50
40
30
20
10
0
87.4
73.1
72.8
57.1
2002
55.7
46.1
2005
2008
Males
Females
Sex
Source: SABSMM Survey, 2008
Main reason for pregnancy
Source: Kaiser/SABC Survey, 2006
An ecological approach
Individual
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Institutional
Sexual behaviour
Age mixing
Contraceptive use
Knowledge, beliefs,
attitudes
• Risk perception
• Substance use
• Childhood abuse
• Schools
• Health care services
Interpersonal
Public policy
• Family (structure,
monitoring,
communication, bonding)
• Partners (gender
relations)
• Peers, Communities
Structural
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Cultural context
SES & poverty
Residential area
Education (drop out)
Family planning services
Sex education
Access to education
Social grants
Determinants continued
• Teen fertility results from complex set of factors
related to the social conditions under which
teens grow up. These include:
– School dropout
– Growing up in poor areas (informal & rural)
– Absence of parents in the home
– Stigma limits:
• open communication with parents &
partners
• access to health services
• results in gaps in knowledge & poor
access to contraception
Determinants continued
– Imbalanced gender relations that often
involves coerced or forced sex
– Poverty that results in trade-offs between
health & economic security e.g.,
• reciprocity of sex in exchange for material
goods,
• remaining in dysfunctional relationships
• involvement with multiple partners & with
older men
• Poverty stacks risk factors among some youth
limiting access to information & incentives to
protect against pregnancy
Young Fathers
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Paucity of research on young fathers
But same profile as young mothers
Strong emotional response to fatherhood
Express deep sense of responsibility
– Motivated by absence of own fathers
• Identify caring & financial roles
– But providing overtakes caring
• Barriers to fatherhood
– Unemployment
– Negotiation of paternity
– Breakdown of relationship
Interventions
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Limits of empirical evidence
Comprehensive & integrated approaches
SA mainly focused on sexual risk factors
Yet relational & structural factors are key
determinants
• A strong focus on young men is required
• Primary focus must be on prevention
• But second chances needed to prevent the loss
of human potential
Recommendations
Prevention
• Universal implementation of sex
education
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Distinct focus on pregnancy
Focuses on both abstinence & safe sex
Address biological and social risk factors
Address barriers to implementation
Involve peer educators & NGOs as a support
Evaluate programmes
Recommendations continued
• Targeted interventions for high risk groups
– e.g., those repeating grades, abused,
substance use, living in poverty
– schools in poor areas & involving age mixing
• Interventions to retain learners in school
– e.g. conditional cash transfers
– Re-enrolment in alternative education
system
• Service learning: involvement in community
work
Recommendations continued
Second chances
• Flexible school policies must be consistently
implemented
– Address barriers to learning
• advocacy & rights vs. demand
• ensure prompt return post-pregnancy
• catch-up academic programmes
• Strong referral systems to social services
– child care support
– access to social grants
– health services
Recommendations continued
• Communities: Community-based interventions
focusing on reproductive health, gender
relations, & livelihood strategies
• Health: Roll out of adolescent friendly services
& access to contraception including emergency
contraception
• Parents: Promoting open communication,
parent-child bonds & setting & enforcing rules
• Mass media: Increase the intensity & coverage
with distinct focus on pregnancy
Conclusions
• Teen fertility has been declining in SA
• Largely due to legislative & biomedical
interventions
• But rates remain unacceptably high
• Focus required on relational & structural risk
factors
• Drop out is a key risk factor
• Best social protection that the education system
can offer is to retain learners in school
Way Forward for the DoBE
• Drawing on recommendations, must
address holistically, using gender-sensitive
and rights-based approaches
• Taking into account social context within
which girls fall pregnant, recognising
determinants of poverty and social
relationships
• Developing strategies that are responsive,
and avoid individual blame and one size fits
all approaches
Way Forward
• Reduction and prevention strategies must
involve other role players and stakeholders
• Sector-wide partnership approach essential
• Intra-governmental work, working with
community based and non-governmental
organisations and crucially parents.
• Constructive partnerships with parents and
school communities will ensure realisation
of vision where all learners can reach their
full potential
Seminar
• Seminar held on 28 August 2009 at Constitution
Hill. Attended by representatives from
government departments, NGOs working in the
area of adolescent sexuality and health, teacher
unions, school governing body associations,
provincial education departments, amongst
others.
• Report was presented and responses from
learners (G/BEM members), DSD, DOH, and
the Department of Basic Education.
Seminar
• Discussions at the seminar focused on key
findings of the report, and included:
• Poverty and social relationships
• Peer pressure and lack of information
• Parenting skills and importance of parents in
prevention programmes
• Influence of mass media on young people’s
behaviour
• Importance of peer education and other
intervention programmes
• Self-esteem and self-respect of young people
Seminar
• Opportunities for young people and extracurricular activities
• Second chances for teenage mothers
• Empowering educators in sexuality education
• Managing prejudice in clinics towards young
people
• Importance of inter-sectoral management of
challenges
• A robust monitoring and evaluation strategy
needed.
What Happens Next
• Study presented to the Cluster and to
Cabinet
• A Series of provincial discussions on the
research report, bringing together key
education and social stakeholders, in
partnership with provincial education
departments
• These will include particular groups with
interest in adolescent health and sexuality
issues, including religious leaders, traditional
leadership groups, teacher unions, amongst
others
What Happens Next
• Development of a comprehensive strategy
for the management and prevention of
schoolgirl pregnancy, focusing on
communication and prevention
programmes, policy, inter-sectoral
collaboration and support for management
of pregnancy in the education system
• This will include exploration of policy
options relating to teenage pregnancy in
education.
What Happens Next
• Strategy will include number of
interventions:
• Developing tools to identify high risk schools
for targeted support
• Developing early warning systems for
schools to identify those who are vulnerable
or likely to drop out
• Developing monitoring and evaluation tools
to track effectiveness of policy in addressing
learner pregnancy
What Happens Next
• Improving lifeskills programmes and
formal sexuality education in schools
• Strengthening and supporting existing
peer education and school-based
programmes, including GEM/BEM
• Continuing and improving focus on
advocacy and communication
What Happens Next
• Intra-governmental task team on adolescent
health and sexuality to focus on
partnerships for the reduction of teenage
pregnancy, further research necessary, key
areas for collaboration, improved referral
and support systems, and necessary data
collection
• Will draw on support from key nongovernmental partners