«Suggested citation: Panday, S., Makiwane, M., Ranchod, C., & Letsoalo, T. (2009). Teenage pregnancy in South Africa - with a speciﬁc focus on ...»
Studies conducted in SA conﬁrm the link between lower socio-economic status and risky sexual behaviour as well as teenage pregnancy. Analysing household survey data collected in 2001, Hallman (2004) found that socio-economic disadvantage signiﬁcantly increased the likelihood of a range of unsafe sexual behaviours and experiences, especially for females. These include early sexual debut, multiple sexual partnerships and lower levels of condom use at most recent sexual encounter. Similar results are reported in other South African studies (Dinkelman et al., 2008; Kelly & Parker, 2000). Poverty also raises young women’s chances of experiencing coerced sex, both at sexual debut and during their lifetime as well as engaging in transactional sex. Hallman’s (2004) analysis also revealed that lower socio-economic status reduces the odds of communicating with one’s partner about safe sexual practices for both males and females. Poorer young women were signiﬁcantly more likely to have lower access to family planning information and to have experienced a pregnancy (Hallman, 2004).
Socioeconomic disadvantage can lead to early childbearing through many different pathways (Kearney & Levine, 2007). Socio-economic status impacts the immediate context of pregnancy prevention, with higher status permitting greater access to information and better education, contraceptive services and child care facilities (Jewkes & Christoﬁdes, 2008). Adolescents who come from impoverished backgrounds may be unaware of the different possibilities available to them, thus limiting their ability to make optimal choices. In fact, data from KwaZulu-Natal showed that between 1999 and 2001, learners attending low resourced schools were less likely to receive life skills education than high resourced schools (Magnani et al., 2003).
Growing up in disadvantaged circumstances reduces the incentive to avoid early motherhood (Kearney & Levine, 2007). Adolescents raised in poverty-stricken households may have been subjected to dysfunctional schools, poor education quality and may lack the motivation to prevent pregnancy perceiving they have little positive options (Grant et al., 2002; Jewkes & Christoﬁdes, 2008). The poor employment opportunities in these communities may further deter adolescents from staying in school and preventing pregnancy (Kearney & Levine, 2007). With low expectations about their own successes and future optimism, there is less incentives to prevent unwanted pregnancy (Jewkes & Christoﬁdes, 2008; Stevens-Simon & Lowy, 1995). In fact Hendriksen et al., (2007) showed that optimism about the future was a signiﬁcant predictor of condom use amongst young men.
71 Teenage pregnancy in South Africa - with a speciﬁc focus on school-going learners Poverty in SA is pervasive. Using the Income and Expenditure Survey data and a poverty line of R322 a month, Bhorat & van der Westhuizen (2008) showed that poverty has declined by only ﬁve percentage points between 1995 (52.5%) and 2005 (48.0%). What is more, a ﬁfth of the population (22.7%) still live in severe poverty (R174 per month). Poverty largely concentrates among the Black (56.3%) and Coloured (34.2%) population groups although these groups experienced the largest declines in poverty between 1995 and 2005. Poverty also concentrates among young people. In 2003, the Status of Youth Report (Richter et al., 2005) showed that 34% of young people aged 18-35 were poor and 16% were ultra poor.
Another measure of disadvantage in SA is the unemployment rate. In 2007, 22% of the population were unemployed (Stats SA, 2007). Young people (51%), in particular, Black males (47.3%) and females (57.8%) aged 15-24 years bear the weight of the unemployment crisis in SA. In a context of high rates of poverty and unemployment the incentives to practice safe sex are few. Although young people in SA are generally optimistic about the future (87%) (Kaiser Family Foundation & SABC, 2006) and place high value on living a healthy life (93%), two thirds are concerned about not being able to ﬁnd a job (68%) and being able to support their families (67%). It is these immediate concerns for economic security that confer risk either through lower incentives or through reciprocity of unprotected sex in exchange for ‘lifts to school, gifts and subsistence cash’ (MacPhail & Campbell, 2001). The inextricable link between adolescent motherhood and poverty and socio-economic disadvantage means that strengthening the negotiation and communication skills of young women and providing access to health services may not be enough (Hallman, 2005) to decrease risk for pregnancy, STIs and HIV. These measures need to be supported by efforts to build the skills of women and create opportunities for livelihoods that would minimise trade off between health and economic security.
Government policy has the power to inﬂuence the trajectory of teenage pregnancy through both direct and indirect ways. Policy decisions can determine the availability (or the lack thereof) of resources to provide critical services and to implement programmes (Brindis, 2006). Highly politicised debates on public policy has the capacity to determine the direction of policy, the types of services that are made available to young people (Brindis, 2006) and to raise the consciousness of the public about the issue being discussed, often with the potential of producing shifts in norms. As the agency of young people to inﬂuence their own development and that of others is increasingly recognised, they become targets of policies and programmes (NRC & IOM, 2005).
Some policy decisions are targeted at youth directly as primary decision makers, while others inﬂuence the context in which young people are growing up (NRC & IOM, 2005).
But the impact of national policy and programmes is often hard to measure and the available evidence, particularly, in developing countries is thin (NRC & IOM, 2005). Nevertheless, the declining teen pregnancy rates in SA have occurred in parallel with the institution of an enabling policy environment for young people.
These include the increased availability of family planning services including termination of pregnancy, policies on life-skills education in schools, and government-funded media campaigns (Jewkes & Christoﬁdes, 2008).
The latter two, although driven by rising HIV and AIDS rates among young people, have conferred beneﬁts to teenage pregnancy. Other more indirect policy beneﬁts have accrued through increased access to educational and economic opportunities for young people and the availability of social grants such as an old age pension and the child support grant that have enabled parents to keep their children in school (Samson et al., 2004). The progressive approach adopted by the Department of Education to allow pregnant girls to remain in school and to return to school post-pregnancy has to some extent mitigated the educational and economic consequences 72 Teenage pregnancy in South Africa - with a speciﬁc focus on school-going learners of teenage pregnancy. In addition, it has also prevented the rapid childbearing that generally follows ﬁrst birth.
Despite a low mean age at ﬁrst birth, second birth is signiﬁcantly delayed in SA (Garenne et al., 2000) because of the opportunity to continue education (Kaufman et al., 2001).
While experts in the ﬁeld have made the logical association between enabling policy and declines in teenage fertility in SA, much more rigorous empirical evidence is needed to support these conclusions. This is especially important in light of the fact that popular and political perception is that teenage fertility is increasing.
South Africa is notable as a society where there are lower levels of marriage in comparison to many parts of the world. This manifests as late age at ﬁrst marriage and low marriage prevalence among women throughout their reproductive stage. However, late marriage or its absence has not led to postponement of reproduction by young people. Indeed, sexual activity tends to start immediately after the onset of puberty as was the case traditionally. Thus, as the age of onset of puberty is declining – because of improving nutritional status, so has the start of the reproductive life of young people. The Status of the Youth Survey 2003 showed that the median age at sexual debut for young people aged 18-24 years was 16 for males and 17 for females (Richter et al., 2005). The median age of ﬁrst birth of all women surveyed was found to be 20.
The HSRC Status of Youth Survey 2003 was used to identify the determinants of early pregnancy. As the median age of experiencing a ﬁrst pregnancy was found to be 20, early pregnancy would fall within teenage years. The selection of independent variables was based on the socio-ecological model, which identiﬁes different levels of inﬂuence for health-related behaviours and conditions: (1) individual, (2) interpersonal, (3) institutional, (4) community, and (5) public policy (National Cancer Institute, 2005). The table below presents only a sub-set of these levels, which were available in the Status of the Youth Survey data. These include family structure, location of childhood residence, the family economic situation and whether the child dropped out of school before becoming pregnant.
The logistic regression analysis outlined below predicts the probability of a woman experiencing an early pregnancy, under given social conditions. For example, a woman who grew up with both her mother and father has 71 out of 100 chances of experiencing a pregnancy (indicated by the odds ratio on the table) compared to a woman who grew up with other relatives. Only factors that have signiﬁcance value (indicated in the table as sig) lower than 0.05 are regarded as having an impact on teenage fertility i.e. we are 95% conﬁdent that the difference ascribed to the social condition is unlikely to have occurred by chance.
Source: Status of Youth Survey, 2003 Table 13 above shows that pregnancy among young South Africans is signiﬁcantly inﬂuenced by the family structure, type of childhood residence, and incomplete education. Young people who grew up in families with both parents were least likely to experience early pregnancy. Presence of the mother is generally beneﬁcial in terms of preventing early pregnancies. Young people who grew up in informal settlements compared to other type of residential areas were at highest risk of experiencing early childbearing. In addition, early school dropout almost doubled the odds of teenage childbearing.
The results outlined above indicate that a complex set of factors are related to teenage pregnancy necessitating multilayered intervention strategies. Structural interventions that are aimed at retaining girls in school and mitigating factors associated with dysfunctional families and neighbourhoods are required.
Proﬁle of male partners
Fathers have traditionally played the role of provider in the lives of their children (Bunting & McAuley, 2004;
NRC & IOM, 2005), and when they are absent it places tremendous pressure on the teenage mother (De Villiers & Kekesi, 2004). Many of the negative life outcomes brought about by teenage pregnancy are better managed when the father has strong emotional ties to the child and provides support to both the mother and the child (Larson et al., 1996; Wiemann et al., 2006). By far the majority of studies on early parenthood focus 74 Teenage pregnancy in South Africa - with a speciﬁc focus on school-going learners on young women, shedding little light on the men who have impregnated them and rendering them as ‘invisible or absent’ (Bunting & McAuley, 2004; Coleman, 1998). When information is available about teenage fathers, it is usually from the perspective of the teenage mother (Landry & Forest, 1995; Reeves, 2007; Swartz & Bhana, 2009), and often presents men as perpetrators (Madhavan, Townsend & Garey, 2008; Morrel, 2007; Pattman, 2007).
A new genre of research on fatherhood in SA, however, has questioned the constructions of African males, in particular, as bad and sexually irresponsible (Madhavan, Townsend & Garey, 2008; Richter & Morrel, 2006;
Swartz & Bhana, 2009). While being a provider is a deeply entrenched deﬁnition of what it means to be a father in SA, the changing socio-economic landscape where more and more workers live with their families, means that fathers can begin to extend their role beyond providers to carers, and being more engaged in their children’s lives (Morrell & Richter, 2006). It is this role of father as carer and protector that prompted an advocacy campaign in SA, titled the Fatherhood Project that aimed to gather information about the role that men are playing in their children’s lives together with generating new knowledge about fatherhood.
As a result, a growing body of literature is now available on fatherhood in SA. However, little information is available on who young fathers are and how they experience early parenthood. While inferences can be drawn from the limited body of literature in the US and UK, a recent qualitative study among Black and Coloured young men from impoverished communities in Cape Town and Durban provides invaluable insights into the experiences of young fatherhood (Swartz & Bhana, 2009).
Who are young fathers?
Few studies have examined the risk factors associated with early fatherhood, yet the available evidence suggests that young fathers’ risk proﬁle is no different than that of young mothers. Studies from the US and the UK indicate that young fathers tend to be poor, continuing the intergenerational cycle of teenage fatherhood (Bunting & McAuley, 2004; Coley & Chase-Landsdale, 1998). Young fathers also report low educational attainment and come from low income communities. As a result, they seldom have the ﬁnancial resources to support the child and the mother. Poor educational performance has been identiﬁed as a powerful predictor of young fatherhood, and similar to young women often predates fatherhood (Dearden, Hale & Woolley, 1995).
In fact, secondary analysis of the HSRC 2003 Status of Youth Survey shows, that early school dropout is signiﬁcantly associated with fatherhood in the teenage years. As with young women, premature exit from the schooling system almost doubled the odds of young men fathering a child early on.