Each year, 16 million girls aged 15-19 give birth. 50,000 of them die from complications related to pregnancy and childbirth. And 95 percent of those births occur in developing countries.
Latin America and Sub-Saharan Africa lead the world in this department, with 80 and 120 births, respectively, per 1,000 adolescent females in 2009. But young girls’ bodies are not ready for childbirth, and getting pregnant before the age of 18 is a risk to both mother and child, as a UNICEF report, “Progress for children”, has shown. In fact, childbirth is the leading killer of adolescent girls in Africa.
Better access to and more effective use of contraceptives would help prevent 272,000 maternal deaths worldwide each year, according to a recent Johns Hopkins Bloomberg School of Public Health study. But in ensuring that girls can access and know how to use contraception, education is key, despite various cultural challenges that educating girls often faces.
Studies have shown that keeping girls in school improves their sexual and reproductive health. A recent released report by Save the Children shows that the higher a mother’s level of education, the lower children’s under-five mortality rate.
Laura Laski, chief of the sexual and reproductive health technical division at the United Nations Population Fund (UNFPA), told IPS that some families “believe that more education will not contribute to what (young girls) would…become later in life”.
Winifride Mwebesa, senior director of family planning and reproductive health at Save the Children, told IPS about cultural barriers in Sub-Saharan Africa. “Very often, poor families find themselves obliged to marry their children. The tradition has been that as soon as the girl menstruates she needs to get married because you don’t want the shame of having a pregnancy in the house before she is married.”
According to the World Health Organisation (WHO), in the developing world 90 percent of adolescent pregnancies are those of married girls.
Early marriage is a problem in Sub-Saharan Africa because it’s rooted deeply in the traditional values of the community. “Over 30 percent of girls in developing countries marry before 18 years of age; around 14 percent do so before the age of 15,” said Laski. Then, community expectations that girls soon have children prevents them from going to school.
In Latin America, early marriage is not as big a problem as in Sub-Saharan Africa. The report “Jóvenes y derechos” by Family Care International shows that in Latin America, factors related to a higher rate of teenage births have more to do with poverty, sexual abuse, absence of parents, culture and education levels.
María Faget, regional consultant in Latin America and the Caribbean for Family Care International, told IPS that “sexual context is still something not in the open”. Talking about the topic with parents or friends is difficult, and there is a reigning culture mandating that “young people do not need or should not be looking for contraception”, Faget explained.
Efforts in this region focus on providing “friendly services” and a welcoming environment for young people because sometimes, confidentiality is a problem. “These services are open and many times they are opened within hospitals and so young people do not go because they are afraid they are going to meet people, people they know,” said Faget.
In Sub-Saharan Africa, “friendly services” are also trying to be implemented. They include the training of health personnel to provide accurate information to young people without interfering with their own values.
Education as the foundation
In both Sub-Saharan Africa and Latin America, the solution is strongly linked to the improvement of girls’ education.
Mali is a clear example. The percentage of female attendance in primary school between 2005-2010 (latest data) was 55 percent. But this number falls to 24 percent in secondary school, according to UNICEF data.
The number of girls in school is very low and the teenage pregnancy rate is extremely high – 190 births per 1,000 women – as the “Countdown to 2015 report” shows. The number is even higher than the Sub-Saharan Africa average of 120 births per 1,000 women.
Often, families won’t take their girls to school because they are so far away . But Save the Children is working to build community schools there, as well as to create a girls-friendly environment – also important in a family’s decision to let girls go to schools. “We build community schools that are friendly to girls, that have separate latrines,” Mwebesa told IPS.
Family Care International was part of a plan called Plan Andino para la Prevención del Embarazo en Adolescents (Plan Andino to Prevent Pregnancies Among Adolescents) that worked in six countries: Bolivia, Chile, Ecuador, Perú, Venezuela and Colombia.
Of those countries, Colombia has seen major improvement. “Colombia has made enormous effort in friendly health programs,” explained Faget. In 2010, it launched an important communication campaign, “Por el derecho a una sexualidad con sentido,” that had a strong rights component.
Organisations agree that in these reproductive health and sexual education programmes, including young people’s voices is critical. After all, youth are the bridge between health and education systems and what is really needed.
Save the Children relies on youth participation to help develop materials related to sexual education. “We may have an idea of the content that needs to be in, but the format has to be decided by young people,” said Mwebesa.
Family Care International also believes in the importance of youth involvement, because youth can shift attitudes and they can have a big impact in changing culture, explained Faget.
In addition to keeping girls in school, young people need to have access to family planning and receive age-appropriate sex education, which Laski descrbied as “comprehensive sexuality education (where) girls and boys are educated about not only about their sexuality but (also) about…relationships and how to protect and promote human rights”.